- See:
osteoporosis and
hypercalcemia:
- First Generation Bisphosphonates:
- short chain molecules which inhibit the Krebs cycle;
- types:
-
etidronate
-
clodronate
- Second Generation:
- long chain molecules which inhibit fatty chain pathways;
- types:
-
pamidronate
- available in IV form;
-
alendronate
- 0.7% absorption;
- Third Generation:
-
risedronate:
- 6% absorption;
- zolendronate
- available in IV form which can be given on an annual basis;
- protocol:
- if the serum 25-hydroxyvitamin D level is less than 15
ng per milliliter then patients receive a loading dose of either vitamin D
3 or D
2 (at a dose of 50,000
to 125,000 IU given orally or intramuscularly)
14 days before first infusion;
- all
patients received daily supplementation with oral calcium (1000
to 1500 mg) and vitamin D (800 to 1200 IU)
-
exclusion criteria:
- previous hypersensitivity to a bisphosphonate
- calculated creatinine clearance
of less than 30 ml per minute
- corrected serum calcium level
of more than 11.0 mg/deciliter (2.8 mmol per liter) or less
than 8.0 mg /deciliter (2.0 mmol / liter);
- active cancer
- metabolic bone disease other than osteoporosis
- life expectancy
of less than 6 months in the investigator's judgment
- references:
-
Once-Yearly Zoledronic Acid for Treatment of Postmenopausal Osteoporosis.
-
Treatments for Osteoporosis — Looking beyond the HORIZON.
Complications:
- renal effects: nephrocalcinosis renal insufficiency
-
hypocalcemia: total serum Ca monitored first and third days following infusion of
the bisphosphonate;
-
AVN:
-
Bisphosphonates and oral cavity avascular bone necrosis: a review of twelve cases.
-
Bisphosphonate-induced avascular osteonecrosis of the jaws: a clinical report of 11 cases.
-
Does avascular necrosis of the jaws in cancer patients only occur following treatment with bisphosphonates?
-
Osteonecrosis of the Jaw — Do Bisphosphonates Pose a Risk?
-
Uveitis
Bisphosphonate-Associated Contact Stomatitis.
