Medications for Osteoporosis (Bisphosphonates)

Bisphosphonates Facts and Risks

The following is a summary of existing U.S. Food and Drug Administration (FDA) approved medications, and their known side effects: Some of the most commonly prescribed osteoporosis drugs are Bisphosphonates. These are the most common drugs prescribed by physicians for osteoporosis treatment.

Bisphosphonate basic chemical structure

Bisphosphonate basic chemical structure (Photo credit: Wikipedia)

These drugs are antiresorptive medicines, which means they slow or stop the natural process that dissolves bone tissue, resulting in maintained or increased bone density and strength (ACOG, 2008). Specifically they stop the process of the osteoclasts. This is the process where the older osteoblasts are dissolved in favor of the newer osteoblasts that are migrating into the outer cortex, the hard outer layer. The process of the bisphosphonates forces the body to keep the older bone cells, but as bone cells refresh on a 6 year basis cycle, eventually this process will falter, as research has shown (Coxon, et al., 2000). The current prescribed bisphosphonates are alendronate sodium (Fosamax), risendronate (Actonel), and ibandronate (Boniva), zoledronic acid (Reclast), and etidronate (Didronel), which is not approved by the FDA for osteoporosis but it is prescribed in Canada and Europe. These are the bisphosphonate side effects:

1. Esophagus complications: These problems include irritation, inflammation, or ulcers of the esophagus, which can sometimes bleed.

2. Low calcium levels in your blood (hypocalcemia): Low blood calcium must be treated before you take a Bisphosphonate medication. Most people with low blood calcium levels do not have symptoms, but some people may have symptoms. Symptoms include, spasms, twitches, or cramps in your muscles, numbness or tingling in your fingers, toes, or around your mouth.

3. Bone, joint, or muscle pain.

4. Severe jaw bone problems (osteonecrosis): The jaw bone begins to lose blood supply. The bones then collapse, leading to pain and arthritis, which can hinder the use of the jaw.

5. Abnormal thighbone fractures.

 

Sources:

American College of Obstetricians and Gynecologists (2004, reaffirmed 2008). Clinical management guidelines for obstetrician-gynecologists. Osteoporosis. ACOG Practice Bulletin No. 50. Obstetrics and Gynecology, 103(1): 203–216.

Coxon FP, Helfrich MH, van ’t Hof RJ, Sebti SM, Ralston SH, Hamilton AD, Rogers MJ (2000) Protein geranylgeranylation is required for osteoclast formation, function, and survival: Inhibition by bisphosphonates and GGTI-298. J Bone Miner Res 15:1467–1476. Ebetino FH and Dansereau

U.S. Food and Drug Administration (2010). Bisphosphonates (marketed as Actonel, Actonel+Ca, Aredia, Boniva, Didronel, Fosamax, Fosamax+D, Reclast, Skelid, and Zometa)

 

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