What are the risks of bisphosphonates?

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Health is an important aspect in humans. Both physical and mental health is important to be taken care of as it helps with a person’s life. Being healthy both physically and mentally can be a great way for humans to be able to have a good life. However, humans cannot run away from being sick. Here is where medicine is needed to help improve health. In this DoctorOnCall’s article, we will learn about bisphosphonates, one of the medicines widely used.

Bisphosphonates are a group of drugs that mainly works in slowing down bone loss. In other words, it is a group of medicines used to treat conditions such as osteopenia and osteoporosis. These two conditions are common, one associated with thin or fragile bones. Such medications help to strengthen bones and prevent future bone fractures. Examples of the common bisphosphonate are risedronate, alendronate and zoledronic acid.

To understand how bisphosphonate works, we need to understand how the normal bone is. Bone formation starts in fetus 6 months before birth. It is not generally complete until adolescence. This is why most people reached their maximum height around this time. Bone growth take place at the ends of the long bones. The space where growth occurs is known as growth plate. The centre of the growth is the disk of cartilage. Growth occurs when cartilage is divided and arranged in columns. It is only here that bones grow longer. Younger cartilage will continue to multiply while the older cartilage begins to harden as it is surrounded by minerals. The harden cartilage then become the bone.

However, the bone will stop growing in length in early adulthood. This will lead to increased thickness or diameter when in response with stress from muscle activity or weight. This is known as appositional growth. Osteoblast will form a compact bone around the external bone surface whereas the osteoclast will break down the internal bone surface. The two processes help in increasing bone diameter while keeping the bone in shape from becoming too heavy or bulky. In the case of osteoporosis or osteopenia, the osteoclast works more than the osteoblast, causing the bones to become weak and fragile.

Thus, what bisphosphonates do is to tackle the osteoblast and osteoclast function. Bisphosphonate reduces the osteoclast activity by lowering the osteoclast cells and promoting the osteoclast apoptosis (death). This will also cause the osteoclast to detach from the bone surface. Bisphosphonate also has a beneficial effect on osteoblast as it enhances the number of osteoblasts on the bone surface and provides more time to promote bone formation.

Now that we know how bisphosphonate works, you may wonder if this drug does have risks. Similar to many other medicines, bisphosphonate does pose risk to those using it. Risk includes stomach pain, irritation to the food pipe, swallowing difficulties and stomach ulcer. In general, side effects are rare as most patients are well-tolerated with bisphosphonate. Bisphosphonate given through intravenous may have flu-like symptoms but often resolves with pain relief and goes away within a few days. The most rare side effect is osteonecrosis in which the cells in jaw bone die.

Most bisphosphonates are taken anywhere between once a week to once a month. Most of the bisphosphonates are in the form of tablets except zoledronic acid in the form of intravenous. It is best to not lie down for 30 minutes after taking medications to reduce the likelihood of gastrointestinal problems. Some patients may be prescribed supplements such as calcium and vitamin D to help maximise the bisphosphonate effect. Even so, it is advisable to not take any supplement or drugs, especially calcium together with bisphosphonate as it can affect bisphosphonate action. This means that calcium supplements should not be taken for at least 60 minutes after taking oral bisphosphonates. If a patient planned to go for a procedure affecting the jaw such as tooth extraction or has had a history of dental infections or malignancy before, it is recommended to get a dental exam prior to taking bisphosphonates.

It can be concluded that bisphosphonate is medicine used to treat osteoporosis or osteopenia. The drug works by slowing down the rate of bone loss. Bisphosphonate is mostly available in the form of oral but there is in the form of intravenous solution. Most patients can tolerate well with bisphosphonates but there are side effects that should be expected in certain cases. It is important to take medication as directed by doctors. Side effects should not stop a person from taking medication and the patient should discuss the matter with their doctor.

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Do you know that osteoporosis not only affects older adults? It can affect men who were taking medication such as glucocorticoid for a long period of time. Bisphosphonate may also be given to treat Paget disease of the bone, malignancies with metastasis to the bone and osteogenesis imperfecta in children. Bisphosphonates are also given to prevent osteoporosis in those who take glucocorticoid medication.

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