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Osteoporosis: treatment options
Published in Barry G. Wren, Progress in the Management of the Menopause, 2020
Safety is more difficult to demonstrate than efficacy. Concerns about the risk of breast cancer remain with HRT. The bisphosphonates remain in bone permanently. Osteomalacia may occur if etidronate is taken incorrectly. Although alendronate was well tolerated in clinical trials, gastrointestinal side-effects may occur when the drug is taken incorrectly. Few data are available for drugs of any kind beyond 3 years so that close monitoring will be needed when HRT, the bisphosphonates and vitamin D metabolites are in widespread use in the prevention and treatment of osteoporosis.
Safety Pharmacology and the GI Tract
Published in Shayne C. Gad, Toxicology of the Gastrointestinal Tract, 2018
Almost 100 different drugs are known to cause esophageal damage [10]. Aspirin, tetracycline, quinidine, potassium chloride, vitamin C, and iron can all cause esophageal ulcers. Alendronate as well as other bisphosphonates can cause esophagitis, including severe ulcerations. Patients should take alendronate and other drugs in its class with at least 180 mL of water and remain in an upright position for at least 30 minutes before eating to prevent esophageal ulceration. Bisphosphonates are a local irritant to the gastrointestinal tract. The comparable molecular structure of bisphosphonates and phosphatidylcholine create competitive binding on the gastrointestinal lining. When bisphosphonates bind, the hydrophobic barrier is destroyed, and gastric acid is able to reach the epithelium resulting in irritation.
Advances in Avascular Necrosis of the Hip joint
Published in K. Mohan Iyer, Hip Joint in Adults: Advances and Developments, 2018
Bisphosphonates inhibit osteoclasts, which would result in the inhibition of bone resorption and decrease remodelling and may eventually reduce the incidence of collapse. The longest study, of 10 years, showed that 87% of the cases treated with alendronate did not need surgical interventions and that the best time for starting medications is before the collapse stage. On the contrary, in a new multicentre randomised controlled trial (RCT) study [76] they found that there is no difference in the treatment of patients with alendronate or a placebo. Studies about the effects of other medications, such as statin [77–80], anticlotting drugs (including enoxaparin) [77], lipoic acid [78], antiapoptotic factors [79], growth factors [80] and herbal remedies [81], have been done, but most studies have low evidence (level IV) and the results are limited; therefore their results cannot be recommended for treatment.
Gaps in evidence on treatment of male osteoporosis: a Research Agenda
Published in The Aging Male, 2023
Adam J. Rose, Susan L. Greenspan, Guneet K. Jasuja
A few short-term studies of up to 2 years in men did report fracture reduction. A randomized double-blind placebo-controlled trial by Orwoll and colleagues evaluated the efficacy of 10 mg of alendronate daily among 146 men with osteoporosis, compared to 95 men who received a placebo [20]. The study found that alendronate was associated with increased bone mineral density (BMD). Alendronate prevented radiologically-detected vertebral fractures (0.8% vs. 7.1%, p = 0.02) and was associated with a statistically significant decrease in loss of height (0.6 mm vs. 2.4 mm, p = 0.02). The study did not detect a statistically significant difference in clinically apparent (painful) vertebral fractures (0.7% vs. 3.2%, p = 0.30) or non-vertebral fractures (4.1% vs. 5.3%, p = 0.80). Similar results were noted in a larger 24-month double-blind randomized trial of zoledronic acid, another bisphosphonate on BMD and vertebral fractures among men with osteoporosis [21].
Metformin use is associated with a lower risk of osteoporosis in adult women independent of type 2 diabetes mellitus and obesity. REDLINC IX study
Published in Gynecological Endocrinology, 2020
Juan E. Blümel, Eugenio Arteaga, Sócrates Aedo, José Arriola-Montenegro, Marcela López, Mabel Martino, Carlos Miranda, Octavio Miranda, Desireé Mostajo, Mónica Ñañez, Eliana Ojeda, Susana Pilnik, José Rojas, Carlos Salinas, Lida Sosa, Poli M. Spritzer, Konstantinos Tserotas, María S. Vallejo, Alejandra. Belardo, Tayane M. Fighera, Peter Chedraui
Metformin is a drug not only used to treat diabetes mellitus, but also used for other conditions such as insulin resistance and obesity [14]. Therefore, it is not of surprise that in this study we found that 27% of metformin users were not diabetic. We found a lower risk of osteoporosis among metformin users, an effect that was independent of type 2 diabetes, obesity, and age. To the best of our knowledge, we have not found studies evaluating such association (metformin use versus osteoporosis) in non-diabetic individuals; yet there is research among diabetics and experimental animals. A study that compared BMD in diabetics showed that metformin was able to block bone loss induced by rosiglitazone [15]. A model in rats suggests that metformin prevents glucocorticoid-induced bone loss by suppressing bone resorption and stimulating bone formation in the trabecular bone. Contrary to this, alendronate only suppresses bone resorption [16].
Drug treatment strategies for osteoporosis in stroke patients
Published in Expert Opinion on Pharmacotherapy, 2020
Cheng-Yang Hsieh, Sheng-Feng Sung, Huei-Kai Huang
Oral bisphosphonates have several disadvantages for patients with stroke. First, dysphagia or drowsiness after acute stroke may limit the use of oral drugs. Additionally, oral bisphosphonates are poorly absorbed from the gastrointestinal tract and must be taken on an empty stomach. Therefore, patients have to avoid taking any food for at least 30 minutes after intake of alendronate or risedronate, or 60 minutes after ibandronate. In addition, patients must remain upright, whether standing or sitting, for 30 minutes after taking oral bisphosphonates to avoid gastrointestinal side effects such as difficulty in swallowing, esophageal inflammation, and gastric ulcers [47]. Such drugs may be damaging to the mucosa of the esophagus even when administered via the nasogastric route and are thus not recommended in the presence of swallowing difficulties or an inability to sit or stand up straight [33]. These factors limit the use of oral bisphosphonates in patients after stroke.