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Thursday, February 9, 2012

Two Rare but Major Adverse Effects of Bone Resorption Preventing Drug

Posted by Dr Prahallad Panda on 8:16 PM Comments

Bisphosphonates like alendronate and zolendronic acid are in frequent use for thinned bone disease called osteoporosis/osteopenia. They prevent the action of cells in the bone responsible for bone resorption, the osteoclasts.
Generally, the drugs are well tolerated; but, two adverse effects are very much disturbing. Those can be;
To prevent the osteonecrosis of jaw bone the advice is to stop bisphosphonates long before any dental procedure. The best thing to see the absolute indication to prescribe the drugs. It should be prescribed to patients having T-Score in BMD (Bone Mineral Density) test less than -2.00 SD.
According to World Health Organization (WHO) 10% to 25% below peak adult bone mass (Average 30 years old), or a T-score between –1.0 and –2.5 standard deviations below normal can be called as osteopenia.
Patients having T-Score more than -2.00 SD (Standard Deviation) can be managed without bisphosphonates. In principle alternative therapies like exercise, lifestyle modification from more sedentary to active lifestyle, vitamin D and calcium supplementation etc. can be offered to those.
The incidence of atypical femur fracture (atypical because the fractures  are more or less transverse and occur at a bony prominence) can be one in one thousand patients from Bisphosphonates use. The can be stopped after five years of use. And after stopping the drug after first atypical femur fracture, second fracture usually can be prevented.
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