Sunday 1 December 2013

Osteoporosis - treatment - Bisphosphonates

Bisphosphonates:
Prevent bone loss by enhancing osteoclast apoptosis and inhibiting bone resorption.
Bind to bone mineral where they remain for years and bone less susceptible to osteoclastic action. Aledronate and risedronate are most commonly used for prevention and treatment of osteoporosis.
These should be taken on an empty stomach with a full glass of water at least 30 mins before any food or water for adequate absorption. Ingestion after food can lead to esophageal injuries as esophagitis, esophageal ulcers,erosions with bleeding.
Interference with the normal healing process that repairs trauma ass with eating is the cause.
Risedronate 5 mg daily is better tolerated.
Weekly adm of aledronate and risedronate, each in a dose of 35 mg reduces side effects with similar results.
Combining bisphosphonate and hormone therapy produces added gain in bone density.
There is a theoreotical concern that over  suppression of resorption can lead to more brittle bones. Zoledronate can be administered intravenously.

Changes of bone remodeling
Pathophysiology
Signs and symptoms
Risk factors and investigations
Investigations
Diagnostic tests and biochemical markers
Hormonal treatment
Estrogen modulators, calcium
Vitamin D
Bisphosphonates
Calcitonin, Fluoride, Tibolone
Prevention

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