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Adverse reactions and drug-drug interactions in the management of women with postmenopausal osteoporosis

Adverse reactions and drug-drug interactions in the management of women with postmenopausal osteoporosis
Adverse reactions and drug-drug interactions in the management of women with postmenopausal osteoporosis
The pharmacological management of disease should involve consideration of the balance between the beneficial effects of treatment on outcome and the probability of adverse effects. The aim of this review is to explore the risk of adverse drug reactions and drug–drug interactions with treatments for postmenopausal osteoporosis. We reviewed evidence for adverse reactions from regulatory documents, randomized controlled trials, pharmacovigilance surveys, and case series. Bisphosphonates are associated with gastrointestinal effects, musculoskeletal pain, and acute-phase reactions, as well as, very rarely, atrial fibrillation, atypical fracture, delayed fracture healing, osteonecrosis of the jaw, hypersensitivity reactions, and renal impairment. Cutaneous effects and osteonecrosis of the jaw are of concern for denosumab (both very rare), though there are no pharmacovigilance data for this agent yet. The selective estrogen receptor modulators are associated with hot flushes, leg cramps, and, very rarely, venous thromboembolism and stroke. Strontium ranelate has been linked to hypersensitivity reactions and venous thromboembolism (both very rare) and teriparatide with headache, nausea, dizziness, and limb pain. The solidity of the evidence base depends on the frequency of the reaction, and causality is not always easy to establish for the very rare adverse reactions. Drug–drug interactions are rare. Osteoporosis treatments are generally safe and well tolerated, though they are associated with a few very rare serious adverse reactions. While these are a cause for concern, the risk should be weighed against the benefits of treatment itself, i.e., the prevention of osteoporotic fracture.
osteoporosis, adverse drug reaction, drug–drug interaction, bisphosphonate, denosumab, serm, strontium ranelate, teriparatide
0171-967X
91-104
Rizzoli, Rene
682e7962-68b1-469e-8049-754ad7892221
Reginster, Jean-Yves
08b05e27-73dd-4ce9-90e5-d64ec922147a
Boonen, Steven
fbfd999d-e425-406c-b66e-ca1b8150497b
Breart, Gerard
7abf4d68-1385-4599-aa4f-b4d9bf44a1c4
Diez-Perez, Adolfo
19f89c53-003a-469c-92ac-69b0b979f3ec
Felsenberg, Dieter
c99572fa-a8a9-48da-8f90-5ba6253c9c83
Kaufman, Jean-Marc
a2df82a7-fc7f-4e57-a933-624dc46d08f3
Kanis, John A.
f1621d8d-8afb-4d97-9679-2165d88a344d
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Rizzoli, Rene
682e7962-68b1-469e-8049-754ad7892221
Reginster, Jean-Yves
08b05e27-73dd-4ce9-90e5-d64ec922147a
Boonen, Steven
fbfd999d-e425-406c-b66e-ca1b8150497b
Breart, Gerard
7abf4d68-1385-4599-aa4f-b4d9bf44a1c4
Diez-Perez, Adolfo
19f89c53-003a-469c-92ac-69b0b979f3ec
Felsenberg, Dieter
c99572fa-a8a9-48da-8f90-5ba6253c9c83
Kaufman, Jean-Marc
a2df82a7-fc7f-4e57-a933-624dc46d08f3
Kanis, John A.
f1621d8d-8afb-4d97-9679-2165d88a344d
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6

Rizzoli, Rene, Reginster, Jean-Yves, Boonen, Steven, Breart, Gerard, Diez-Perez, Adolfo, Felsenberg, Dieter, Kaufman, Jean-Marc, Kanis, John A. and Cooper, Cyrus (2011) Adverse reactions and drug-drug interactions in the management of women with postmenopausal osteoporosis. Calcified Tissue International, 89 (2), 91-104. (doi:10.1007/s00223-011-9499-8). (PMID:21637997)

Record type: Article

Abstract

The pharmacological management of disease should involve consideration of the balance between the beneficial effects of treatment on outcome and the probability of adverse effects. The aim of this review is to explore the risk of adverse drug reactions and drug–drug interactions with treatments for postmenopausal osteoporosis. We reviewed evidence for adverse reactions from regulatory documents, randomized controlled trials, pharmacovigilance surveys, and case series. Bisphosphonates are associated with gastrointestinal effects, musculoskeletal pain, and acute-phase reactions, as well as, very rarely, atrial fibrillation, atypical fracture, delayed fracture healing, osteonecrosis of the jaw, hypersensitivity reactions, and renal impairment. Cutaneous effects and osteonecrosis of the jaw are of concern for denosumab (both very rare), though there are no pharmacovigilance data for this agent yet. The selective estrogen receptor modulators are associated with hot flushes, leg cramps, and, very rarely, venous thromboembolism and stroke. Strontium ranelate has been linked to hypersensitivity reactions and venous thromboembolism (both very rare) and teriparatide with headache, nausea, dizziness, and limb pain. The solidity of the evidence base depends on the frequency of the reaction, and causality is not always easy to establish for the very rare adverse reactions. Drug–drug interactions are rare. Osteoporosis treatments are generally safe and well tolerated, though they are associated with a few very rare serious adverse reactions. While these are a cause for concern, the risk should be weighed against the benefits of treatment itself, i.e., the prevention of osteoporotic fracture.

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More information

Published date: August 2011
Keywords: osteoporosis, adverse drug reaction, drug–drug interaction, bisphosphonate, denosumab, serm, strontium ranelate, teriparatide

Identifiers

Local EPrints ID: 193775
URI: http://eprints.soton.ac.uk/id/eprint/193775
ISSN: 0171-967X
PURE UUID: 0ba32542-5b88-46f0-b9d2-86919725c9dc
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 20 Jul 2011 09:01
Last modified: 18 Mar 2024 02:45

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Contributors

Author: Rene Rizzoli
Author: Jean-Yves Reginster
Author: Steven Boonen
Author: Gerard Breart
Author: Adolfo Diez-Perez
Author: Dieter Felsenberg
Author: Jean-Marc Kaufman
Author: John A. Kanis
Author: Cyrus Cooper ORCID iD

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