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Long-term treatment with bisphosphonates and their safety in postmenopausal osteoporosis

Long-term treatment with bisphosphonates and their safety in postmenopausal osteoporosis
Long-term treatment with bisphosphonates and their safety in postmenopausal osteoporosis
Bisphosphonates are the leading drugs for the treatment of osteoporosis. In ­randomized controlled trials (RCTs), alendronate, risedronate, and zoledronate have shown to reduce the risk of vertebral, nonvertebral, and hip fractures, whereas RCTs with ibandronate show antifracture efficacy at vertebral sites. Bisphosphonates are generally well tolerated and safe. Nevertheless, adverse events have been noted, and it is important to consider the strength of the evidence for causal relationships. Effects on the gastrointestinal tract and kidney function are well recognized, as are transient acute-phase reactions. Atrial fibrillation was first identified as a potential adverse event in a zoledronate trial, but subsequent trials and analyses failed to substantiate an association with bisphosphonates. Case reports have suggested a relationship between oral bisphosphonates and esophageal cancer, but this has not been demonstrated in epidemiologic studies. A possible association between bisphosphonate use and osteonecrosis of the jaw (ONJ) has also been suggested. However, the risk of ONJ in patients with osteoporosis appears to be very low, with no evidence from prospective RCTs of a causal association. There are reports of occasional occurrence of subtrochanteric or diaphyseal fractures in osteoporotic patients, but an association with bisphosphonate therapy is not substantiated by epidemiologic studies or prospective RCTs.
bisphosphonates, osteoporosis, safety
1176-6336
325-343
Pazianas, Michael
dcba1270-21c4-4b16-b0ca-4ec9ad12eecc
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Ebetino, F. Hal
04c55825-ad41-404d-b5a0-1dc5c5222d9e
Russell, R. Graham G.
055e01f6-6175-4437-aaa0-a78659799dca
Pazianas, Michael
dcba1270-21c4-4b16-b0ca-4ec9ad12eecc
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Ebetino, F. Hal
04c55825-ad41-404d-b5a0-1dc5c5222d9e
Russell, R. Graham G.
055e01f6-6175-4437-aaa0-a78659799dca

Pazianas, Michael, Cooper, Cyrus, Ebetino, F. Hal and Russell, R. Graham G. (2010) Long-term treatment with bisphosphonates and their safety in postmenopausal osteoporosis. Therapeutics and Clinical Risk Management, 21 (6), 325-343. (doi:10.2147/TCRM.S8054).

Record type: Article

Abstract

Bisphosphonates are the leading drugs for the treatment of osteoporosis. In ­randomized controlled trials (RCTs), alendronate, risedronate, and zoledronate have shown to reduce the risk of vertebral, nonvertebral, and hip fractures, whereas RCTs with ibandronate show antifracture efficacy at vertebral sites. Bisphosphonates are generally well tolerated and safe. Nevertheless, adverse events have been noted, and it is important to consider the strength of the evidence for causal relationships. Effects on the gastrointestinal tract and kidney function are well recognized, as are transient acute-phase reactions. Atrial fibrillation was first identified as a potential adverse event in a zoledronate trial, but subsequent trials and analyses failed to substantiate an association with bisphosphonates. Case reports have suggested a relationship between oral bisphosphonates and esophageal cancer, but this has not been demonstrated in epidemiologic studies. A possible association between bisphosphonate use and osteonecrosis of the jaw (ONJ) has also been suggested. However, the risk of ONJ in patients with osteoporosis appears to be very low, with no evidence from prospective RCTs of a causal association. There are reports of occasional occurrence of subtrochanteric or diaphyseal fractures in osteoporotic patients, but an association with bisphosphonate therapy is not substantiated by epidemiologic studies or prospective RCTs.

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Published date: July 2010
Keywords: bisphosphonates, osteoporosis, safety

Identifiers

Local EPrints ID: 162333
URI: http://eprints.soton.ac.uk/id/eprint/162333
ISSN: 1176-6336
PURE UUID: 15d67257-e7ad-4370-8b49-2db1c6e538f8
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 19 Aug 2010 07:49
Last modified: 18 Mar 2024 02:45

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Contributors

Author: Michael Pazianas
Author: Cyrus Cooper ORCID iD
Author: F. Hal Ebetino
Author: R. Graham G. Russell

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