How do you counsel someone starting on a bisphosphonate?
How to take it:
- First thing in morning with 8 oz of water on an empty stomach
- No food or water for at 30 minutes afterwards
- Remain upright until after eating
Why to take it:
The use of Alendronate reduced vertebral and hip fractures by 50% and 30% respectively in FIT trial, in patients who had had a prior vertebral fracture (there was no hip effect if they had had no prior fracture, unless also had frank osteoporosis, in which case vertebra and hip were protected).
Potential side effects:
- GI mucosal irritation, especially if instructions are not followed
- Osteonecrosis of jaw, especially with superimposed cancer: do dental work first
- Bone, muscle or joint pain
- Diaphyseal fractures of the femur
- Transient hypocalcemia
- Do not use if creatinine clearance is <35 ml/min