Drugs

What about Atypical Femur Fractures with antiresorptive medication use? AFF have also been reported in patients being treated with antiresorptive agents; anabolic agents have not been implicated as causative agents. This complication has occurred almost exclusively in those on long-term antiresorptive therapy (>5 years). Any such patient with unexplained thigh pain should be evaluated with …

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What precautions should be considered before prescribing bisphosphonates? • Oral bisphosphonates are contraindicated in patients with esophageal problems (strictures, achalasia, or severe dysmotility [scleroderma], varices), malabsorption, or inability to sit upright. These are indications for an IV formulation. • Oral bisphosphonates are contraindicated in patients with creatinine clearance (CrCl) <30 to 35 cc/minute and IV bisphosphonates are …

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how bisphosphonates are taken and why they work for osteoporosis The oral nitrogenous bisphosphonates are analogs of pyrophosphate, so they avidly bind to bone. They have very poor intestinal absorption (<1%) that is further inhibited by the presence of food or medications in the gastrointestinal (GI) tract. Their major side effect is esophageal and GI …

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What pharmacologic agents are Food and Drug Administration (FDA)-approved, and how are they used? Mechanism Route Dose Frequency Antiresorptive agentsBisphosphonatesAlendronate (Fosamax) a Oral 10 mg70 mg DailyWeekly Risedronate (Actonel) a Oral 5 mg35 mg150 mg DailyWeeklyMonthly Risedronate SR (Atelvia) Oral 35 mg Weekly Ibandronate (Boniva) OralIV 150 mg3 mg Monthlyq3 Months Zoledronic acid (Reclast) IV 5 mg …

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How do the medications for osteoporosis work? Osteoporosis medications are classified into two main categories—antiresorptive agents and anabolic agents. Antiresorptive medications include the bisphosphonates, denosumab, estrogens, raloxifene, and calcitonin; these agents work by inhibiting osteoclastic bone resorption. Teriparatide and abaloparatide are the currently available anabolic agents; they work by stimulating osteoblastic bone formation.

When should pharmacologic therapy be initiated for osteoporosis? Pharmacologic therapy should be advised for patients who have any one of the following: • History of a fragility fracture (vertebral, hip, wrist, humerus). • T-score <–2.5 (at any site). • FRAX 10-year risk score >3% for hip fracture or >20% for major osteoporotic fractures. The FRAX tool (Search Engine: …

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How to treat vitamin D deficiency? The goal serum 25 OH vitamin D level is 30 to 100 ng/mL. In general, 1000 units (IU) daily of vitamin D will raise the serum level by 6 to 10 ng/mL. I recommend the following: 25 OH D Level Management 20–30 ng/mL 2000 IU D3 daily 10–20 ng/mL …

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