Bisphosphonates

Abstract

Osteoporosis is the result of bone loss due to an imbalance in bone turnover such that bone resorption exceeds bone formation. Bisphosphonates are potent inhibitors of osteoclast activity that reduce bone turnover and re-establish the balance between bone resorption and formation. In clinical studies, several bisphosphonates prevent bone loss, preserve bone structure, improve bone strength and, in patients with osteoporosis, substantially reduce fracture risk. They are effective in multiple clinical settings including postmenopausal osteoporosis, low bone mass in men and drug-induced bone loss. Intermittent oral dosing and intravenous administration are more convenient than the original daily dosing regimen. These drugs are generally well tolerated and have an excellent safety profile in that serious side effects are uncommon. Potent bisphosphonates are generally the preferred treatment option for most patients with or at risk for osteoporosis. RESUMO Bisfosfonatos.Osteoporose é o resultado da perda óssea devida a um imbalanço no turnover ósseo, onde a reabsorção óssea excede sua formação. Os bisfosfonatos são inibidores potentes da atividade osteoclástica, que reduzem o turnover ósseo e restabelecem o balanço entre a reabsorção e a formação óssea. Em estudos clínicos, vários bisfosfonatos previnem a perda óssea, preservam sua estrutura, melhoram sua força e substancialmente reduzem o risco de fraturas em pacientes com osteoporose. Eles são efetivos em várias situações clínicas, incluindo a osteoporose pós-menopáusica, a reduzida massa óssea em homens e perda óssea induzida por drogas. Doses orais intermitentes e administração intravenosa são mais convenientes do que o esquema original de doses diárias. Essas drogas são geralmente bem toleradas e têm um excelente perfil de segurança, no qual efeitos colaterais sérios são incomuns. Os bisfosfonatos potentes são geralmente a opção terapêutica preferida para a maioria dos pacientes com ou em risco de osteoporose. O STEOPOROSIS IS A DISORDER of skeletal fragility due a combination of low bone mass, deteriorated bone architecture and perhaps alterations in other aspects of bone quality (1). Osteoporosis is usually the result of bone loss that occurs after menopause in women and in older men and women. This bone loss is a consequence of increased and unbalanced bone review article Bisphosphonates

Consequências sistêmicas da cirurgia bariátrica e suas repercussões na saúde bucal

“…Moreover, it is important to know how is the absorption and bioavailability of drugs, such as oral bisphosphonates, which may be compromised in bariatric surgery 37 . Bisphosphonates are drugs that inhibit osteoclasts and are prescribed to patients with an imbalance in bone metabolism leading to osteoporosis 33 . Another consequence often found in people who have undergone Roux-en-Y gastric bypass, is the chronic regurgitation or gastroesophageal reflux; it may be due to the narrow diameter of the silicone ring and also hypotonicity of the lower esophageal sphincter 1 .…”

Bisphosphonates in the treatment of metabolic bone diseases

“…The pathogenesis is still unknown. Although hypothesized as a possible etiology to the problem stronger reduced bone turnover could not be demonstrated in these patients as a risk factor (30).…”

“…Gastrointestinal (GI) symptoms are the most frequent side effects attributed to bisphosphonate use. They occur in about 20%-30% of the patients, usually within the first weeks of therapy (30). Experimental studies have previously demonstrated that these drugs are able to promote upper gastrointestinal injury, especially in the context of preexisting esophageal irritation, Arq Bras Endocrinol Metab.…”

“…Inflammation of ocular structures, allergic manifestations, and abnormal tests of liver function have been reported. These effects are generally mild and self-limited (30). For some intravenously administered bisphosphonates renal toxicity has been described (36), suggesting the need for renal function testing before and during treatment, dose reductions for mild-to-moderate renal impairment, and caution for patients with severe renal dysfunction.…”

Lip Ulceration Associated with Intravenous Administration of Zoledronic Acid: Report of a Case

“…BPs have been successfully used as a treatment option in skeletal disorders including post-menopausal and corticosteroid-induced osteoporosis [13] and Paget's bone disease [14]. Intravenous or oral administration of BPs is commonly used in oncology as a skeletal protector against hypercalcemia and/or bone metastases in cases of multiple myeloma, breast, prostate or other cancers [4].…”