What are Bisphosphonates?

Osteoporosis, commonly known as bone weakening, is treated and prevented using bisphosphonates including alendronate (Fosamax), risedronate (Actonel), zoledronic acid (Reclast), ibandronate (Boniva), and pamidronate (Aredia). The loss of calcium and other elements that help maintain bones strong and dense leads to this disorder. Bisphosphonates are used to treat and prevent osteoporosis. If left untreated, this issue can result in broken bones, bone discomfort, and a shorter overall height.

After menopause, a woman's risk of acquiring osteoporosis is much greater than it was before menopause, even though the risk of developing the disease rises with age for everyone. On the other side, studies have shown that the chronic inflammation that lupus patients experience daily puts them at an increased risk of developing osteoporosis later in life.

Individuals diagnosed with lupus who are prescribed certain medications, most notably corticosteroids like prednisone, have a significantly increased risk of developing osteoporosis due to their therapy.

How do Bisphosphonates Work?

The remodeling of your bones is a continuous process that involves the removal of old bone cells and the depositing of new bone cells. When a person has osteoporosis, their bones lose minerals faster than their body's ability to replace them. Bisphosphonates are medications that slow down or stop the natural processes that cause bone tissue to dissolve, which allows them to help prevent the loss of calcium and other minerals from the bones. Because of this, they contribute to the health and vitality of your skeleton.

If you currently have osteoporosis, these drugs may help prevent bone fractures by preventing further bone loss and slowing the rate at which bone loss occurs (broken bones). Alendronate (Fosamax) and risedronate (Actonel) have both been shown in studies to lower the risk of vertebral fracture by as much as 50%. Spinal vertebrae are individual backbones. Research shows that these medications may prevent additional bone fractures by 30–49%, which is similar to our experience.

What are the Side Effects of Bisphosphonates?

The following are examples of possible adverse reactions to these medications −

  • Headache

  • Stomach pain, Heartburn, and irritation in throat

  • Allergic reaction

  • Dysphagia (difficulty swallowing)

  • Flatulence (diarrhea, constipation, gassy stomach)

  • Burning sensation or pain under the ribs or in the back

  • Dizziness, weakness

  • Numbness, Jaw pain, and swelling

  • Joint and muscle pain

There is a possibility that taking Reclast could lead to a condition known as atrial fibrillation, which is an irregular heartbeat.

Also, some people have problems with the bone healing process (such as osteonecrosis of the jaw), which manifests itself most obviously in the days and weeks after tooth extractions or implant placement. If you are contemplating this kind of treatment, it is important to consult with your primary care physician, who may recommend that you switch to an antibiotic before the operation. If the negative affects you're feeling are too much to bear, it's important to communicate this to your doctor.

Who Should not Consume Bisphosphonates?

If your doctor has not given his or her approval for the medication, the following individuals should not take bisphosphonates −

  • Those who are expecting a baby or who are trying to conceive

  • Those suffering from severe renal difficulties

    • Individuals that suffer from esophagitis

    • Patients who are currently being treated with parathyroid hormone (Forteo), even though there may be some exceptions.

You should talk to your primary care doctor before taking these drugs if you have low blood calcium (hypocalcemia), a vitamin D deficiency, renal illness, or a stomach or esophageal ulcer. You should also talk to your doctor before taking these drugs if you have a history of stomach or esophageal ulcers, vitamin D insufficiency, or renal illness.

Drug Interactions

It's possible for some medications to change the way your body handles bisphosphonates. It's possible that your therapy for lupus may entail more than one medication, but you should still let your doctor know if you're taking any additional medications, whether they're prescribed or over-the-counter, vitamins, or supplements.

Notify your physician in particular if you are using any non-steroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen (Advil, Motrin), celecoxib (Celebrex), naproxen (Aleve, Naprosyn), or other similar medications (Voltaren, Cataflam).

In addition, the process by which your body absorbs bisphosphonates might be hindered by antacids and other dietary supplements that include calcium, magnesium, and aluminium. As a result of this, you should wait at least thirty minutes after taking your bisphosphonate pill before taking any other drugs.

Warnings and Precautions

Don't take bisphosphonates if you −

  • Are hypersensitive to them

  • Having problems with the food pipe (esophagus), such as tears, holes, narrowing, or trouble swallowing, among other esophagus-related issues.

  • Have an advanced case of renal disease

  • Cannot maintain an erect sitting position for at least half an hour.

  • Have insufficient amounts of calcium circulating through your blood.

To avoid the drug from causing irritation to your stomach and esophagus, after orally taking a bisphosphonate, you are advised to remain in an upright posture for at least half an hour. This is the case even if you do not feel any discomfort.

For the Boniva treatment to be effective, you must remain upright the whole time.

Except for Altevia, all tablet forms of bisphosphonates—including those in liquid and capsule forms—should be taken on an empty stomach at least 30 minutes before breakfast. This is the time of day when bisphosphonates should be taken as prescribed.

Boniva should be taken on an empty stomach one hour before meals, whereas Altevia should be taken after meals. Taking Boniva while you have nothing in your stomach is not recommended.

While taking bisphosphonates, the only liquid that should be ingested is a full glass of water; other drinks, such as fruit juice, coffee, soda, or those with flavorings, should not be consumed.

Bisphosphonates must never be used with any other kind of drug. Wait at least half an hour before taking any other medications or supplements in addition to what you are now taking (or an hour if you are taking Boniva).

Updated on: 14-Apr-2023


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