Bisphosphonates The Good and the Bad

Feb 18, 2014
Specialist pharmacists provide insight to understanding bisphosphonates, a common therapy class for osteoporosis.
  • Osteoporosis

Osteoporosis is a progressive degenerative condition caused by an imbalance between cells that break down old bone, osteoclasts and cells that build new bone, osteoblasts. When osteoclasts are more active, it results in progressive bone loss.

Women are at a significantly higher risk for osteoporosis. The team of specialist pharmacists within the Express Scripts Therapeutic Resource Centers that are educated in women’s health issues counsel osteoporosis patients in the most effective management for their disease.

Medication Management

One key area my team and I help patients with is medication management, including safety and adherence. Bisphosphonates are one of the most commonly used therapy classes for osteoporosis. This class of medications have proven effective overall in reducing vertrebral and nonvertebral fractures and having a good overall safety profile.

For patients who are on bisphosphonates, here are a few things that are helpful to know:

  • Bisphosphonates work by decreasing the action of osteoclast cells providing osteoblasts cells an opportunity to restore the balance in favor of bone development, thus reducing the progression of osteoporosis and future fracture risk.
  • Bisphosphonates come in a wide range of dosages and in different forms including tablets, liquids and injectables.
  • Weekly doses are the most common. The medications remain in the body and bones for extended periods and continue to be effective.
  • Certain bisphosphonates can remain at the bone surface for up to 10 years. This is why monthly and yearly doses are not uncommon.

Understanding the Risks

As with all medications, there are risks. My team and I help patients understand these risks and manage them to ensure the best possible outcomes. Some topics we cover with patients who are on bisphosphonates include:

  • Bisphosphonates generally have low absorption rates. They also carry a risk of esophageal and stomach irritation. Because of this, oral forms of the medication should be taken first thing in the morning with a full glass of water. Avoid taking food, drink or other medications for 30 minutes to 60 minutes depending on product used.
  • The patient must also remain upright during that time.
  • Although rare, bisphosphonates can cause osteonecrosis of the jaw (ONJ) or degradation of the jaw bone. Patients with compromised immune systems — such as those undergoing chemotherapy or HIV patients — are at the most risk. Poor oral hygiene and patients undergoing invasive dental procedures also can increase the risk for ONJ. Another rare but serious side effect is atypical fractures that occur in the middle of the femur. Such fractures are different from the classic osteoporotic fractures, which typically occur in the hip. Atypical fractures occur spontaneously or from low impact trauma in patients who have been on bisphosphonate therapy long term. Patients that notice any pain or discomfort in the thigh area should notify their physician for an evaluation.
  • Physicians may halt bisphosphonate therapy after 5 to 7 years of continued treatment to minimize the risk for atypical fractures.
  • The physician will monitor the progress of osteoporosis and after one year will assess whether therapy with a bisphosphonate needs to be restarted.

Bisphosphonates are an important part of an effective osteoporosis treatment plan, but as with all medications, it is important to be aware of your risks. Understanding the risks and possible side effects enable patients to avoid or manage them, thus resulting in greater adherence to therapy and healthier outcomes.

For more information about osteoporosis, talk with your doctor or specialist pharmacist.

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