CLINICAL
OSTEOPOROSIS
BISPHOSPHONATE TREATMENT
IN OSTEOPOROSIS
Osteoporosis is a leading contributor of fractures worldwide, causing more than 8.9 million fractures annually.
Pretreatment evaluation
Before commencing bisphosphonate
therapy, patients should be evaluated
to detect potentially remediable
causes of or other contributing factors
to osteoporosis.
This evaluation includes assessment
for hypocalcaemia, vitamin D deficiency,
and renal impairment by measuring
serum:
• Calcium
• 25-hydroxyvitamin D (25[OH]D)
• Creatinine.
For both oral and IV
bisphosphonates, correction of
hypocalcemia and/or vitamin D
deficiency is necessary prior
to administration.
Osteoporosis affects an estimated
200m women worldwide
(approximately 1/10th of women
aged 60, 1/5th of women aged 70,
2/5ths of women aged 80, and
2/3rds of women aged 90). One in
three women and one in five men over
50 will experience an osteoporotic
fracture. Additionally, 61% of all
osteoporotic fractures occur in women.
It has been predicted that the
incidence of hip fracture is expected
to increase by 310% in men and 240%
in women by 2050. The economic
toll of osteoporosis is expected to
significantly increase. Indeed, it has
been estimated that there is a 40%
lifetime risk for fractures affecting the
hip, forearm and vertebrae (similar to
the risk for cardiovascular disease), with
nearly 75% of these types of fractures
occurring in patients aged 65 years age
and above.
Osteoporosis has been shown to
account for more days spent in the
hospital than diabetes, heart attacks or
breast cancer. It is also a major cause
of disability, which has been shown to
be greater than that caused by cancer
(except lung cancer) and comparable
to or greater than disability from
rheumatoid arthritis, asthma and high
blood pressure related heart disease.
The overall mortality within the first
12 months after a hip fracture is
approximately 20%, being higher in men
than women.
Men make up 20%-25% of all hip
fractures, and have an estimated
30% lifetime risk of experiencing an
osteoporotic fracture when over 50,
similar to the lifetime risk of developing
prostate cancer. Fragility fractures are
26 MAY 2017 | MEDICAL CHRONICLE
the primary cause of hospitalisation
and/or death for US adults ≥age 65 and
above. Furthermore, 44% of nursing
home admissions are due to fractures.
It is obvious that osteoporosis is
extremely common and this condition
leads to disability, costs and even death.
BISPHOSPHONATE THERAPY
Bisphosphonates are a class of
drugs that are used to prevent bone
loss demineralisation (weakening or
destruction). These have been used
since the 1970s, but technological
developments in recent years have
continued to reduce the frequency of
dosage and made other stronger forms
of the drugs available.
Osteoporosis is caused by the
cumulative effect of bone resorption
in excess of bone formation.
Bisphosphonates inhibit bone resorption
with relatively few side effects. As
a result, they are widely used for
the prevention and treatment of
osteoporosis.
Bisphosphonates are also used in the
management of hypercalcemia, Paget
disease, and a number of malignancies,
including multiple myeloma, breast
cancer, and prostate cancer. These
topics are all reviewed separately in the
appropriate topic reviews.
The treatment of osteoporosis
consists of lifestyle measures and
pharmacologic therapy. Lifestyle
measures include adequate calcium
and vitamin D, exercise, smoking
cessation, counseling on fall prevention,
and avoidance of heavy alcohol use.
These mea