When do bisphosphonates make the most sense?
A Cochrane Musculoskeletal Group review
Should you prescribe bisphosphonates for postmenopausal patients for primary as well as secondary prevention of osteoporotic fractures? Here’s what the evidence tells us.
What do you decide to do?
An inability to stay upright for 30 minutes after drug administration is a contraindication to the use of oral bisphosphonates. The presence of upper GI symptoms is also a concern. You offer Mrs. Y the option of a once-yearly IV infusion of zoledronic acid instead, and she and her husband agree to this. Before scheduling a follow-up visit, you discuss the patient’s nutritional intake, and discover that she consumes only a moderate amount of calcium—at most 2 servings of dairy products per day. You also note that her serum vitamin D level was not checked in the hospital. You order lab work, with a view to correcting any deficiency before proceeding with a zoledronic infusion (due to the risk of tetany) and to maintaining her on an appropriate level of calcium and vitamin D intake, using supplements only if necessary.
CORRESPONDENCE Tania Winzenberg, MBBS, Menzies Research Institute, Private Bag 23, Hobart, Tasmania, Australia 7001; tania.winzenberg@utas.edu.au
