Notes for: Biphosphonates and Other DrugsLast edited [11/07/2018 09:59:53]
1. Oral bisphosphonates are absorbed very poorly; therefore counselling should be given to the patient as to how and when administration is most appropriate.
2. Alendronic acid, and possibly risedronate, can cause severe oesophageal reactions. Patients should be advised to discontinue treatment and seek medical attention if they develop symptoms of oesophageal irritation, new or worsening heartburn, pain on swallowing or retrosternal pain. Strict guidelines on administration should be followed.
3. DSU Nov09 advises: The risk of developing osteonecrosis of the jaw (ONJ) with oral bisphosphonates seems to be low. The risk of ONJ is substantially greater for patients receiving I/V bisphosphonates for cancer indications than for patients receiving oral bisphosphonates for oseteoporosis of Paget's disease. To minimise risk all patients should have a dental check-up before bisphosphonate treatment. All other patients who start bisphosphonates should have a dental examination only if they have poor dental status. During treatment, patients should maintain good oral hygiene, receive routine dental check-ups, and report any oral symptoms such as dental mobility, pain, or swelling
4. DSU Jun11 advises: Atypical femoral fractures have been reported rarely with bisphosphonate treatment, mainly in patients receiving long-term treatment for osteoporosis. The need to continue bisphosphonate treatment for osteoporosis should be re-evaluated periodically, particularly after 5 or more years of use. Patients should be advised to report any thigh, hip, or groin pain during treatment with a bisphosphonate. Discontinuation of treatment in patients suspected to have an atypical femoral fracture should be considered after an assessment of the benefits and risks of continued treatment.
5 - DSU Oct12 concerning precautions that should be followed to minimise the risk of hypocalcaemia with denosumab