Pharmacological Management of Osteoporosis with Bisphosphonates
Presented by paige shinn
South University
Osteoporosis
Condition in which bone becomes weakened with an increased risk of fracture.
One of the main reasons for bone fractures among the elderly.
Bones that are at increased risk of fracture include the backbones, the bones of the forearm, and the hip.
Causes of alteration in the balance between resorption and formation (Woo & Robinson, 2015, p. 542):
normal aging,
malignancy,
syndromes of ectopic calcification, and
Paget’s disease
Bone is relentlessly going through a modification process in which osteoblasts build bone and osteoclasts demolish the bone (Maraka & Kennel, 2015).
2
Biphosphonates
Bisphosphonates are medicines for use in the treatment of bone degeneration and are the most frequently used agent recommended for bone loss.
These medicines are helpful in reducing the fracture possibility in patients with a previous history of fractures or malignancy.
Bisphosphonates slow the process of bone loss, diminish bone soreness and inhibit aberrantly high concentration of calcium in blood.
Two different kind of bisphosphonates available, which include:
Nitrogenous Bisphosphonates: such as pamidronate, alendronate, and zoledronate (Poole, 2012).
Non-nitrogenous Bisphosphonates: such as etidronate, clodronate, and tiludronate (Poole, 2012).
Mechanism of action of both these classes is different for destroying the osteoclastic cells.
Biphosphonates
Adhere tightly to bone and inhibit osteoclastic activity (Woo & Robinson, 2015, p. 543).
Poorly enthralled from the gastrointestinal tract.
About 45% of the enthralled drug is taken up by the bone, while the remaining is evacuated unchanged in urine.
Alendronate and risedronate are the drugs of choice for osteoporosis.
Biphosphonates
Dosing and administration
All oral bisphosphonates can cause esophagitis and gastric irritation (Woo & Robinson, 2015, p. 543).
Available in both tablet and injectable form.
Because of GI upset, bisphosphonates should be taken on an empty stomach with water and wait for 30 minutes before taking food and other medicines.
The patient must wait for 30 minutes after taking medicine to go to bed.
For osteoporosis, at least five years treatment is required with bisphosphonates.
5
Potential Effects on Patients (Woo and Robinson, 2015, p. 544)
Barrett’s esophagus
Renal insufficiency
Severe esophageal adverse reaction
Nausea, vomiting, constipation, and diarrhea
Fever, myalgias, and arthralgias
Musculoskeletal pain
In rare cases, osteonecrosis of the jaw
Afib
Nursing Implications (Woo & Robinson, 2015, p. 544)
Monitor serum calcium, serum phosphate, serum alkaline phosphatase, 24 hour urinary calcium, and serum electrolytes.
Check renal and liver functions.
Calcium supplements and antacids should not be taken within one hour of bisphosphonates as it interferes with the absorption.
Risk of GI bleeding is increased with concomitant use of aspirin and NSAIDS.
These drugs are not recommended in patients with moderate to severe renal impairment.
The use of PPIs and SSRIs are recently linked to significant bone loss.
Glucocorticoids are also linked to significant bone loss.
In patients with osteopenia, prophylactic use of bisphosphonates should be considered.
Nursing Implications
Patient education:
Avoid breastfeeding while on this medicine.
Check the directions before taking the medicine.
Contact the provider if have the fever with arthralgia and myalgia.
References
Maraka, S., & Kennel, K. A. (2015). Bisphosphonates for the prevention and treatment
of osteoporosis. BMJ : British Medical Journal (Online), 351doi:http://dx.doi.org/
10.1136/bmj.h3783
Poole, K. E., & Compston, J. E. (2012). Bisphosphonates in the treatment of
osteoporosis. BMJ: British Medical Journal (Clinical Research Edition), 344,
e3211. https://doi.org/10.1136/bmj.e3211
Woo, T., & Robinson, M. (2015). Pharmacotherapeutics for Advanced Practice Nurse
prescribers with DavisPlus Resources, 4th Edition. [South University]. Retrieved
from https://digitalbookshelf.southuniversity.edu/#/books/9780803676374/