Standard osteoporosis drug is making bones weaker
March 1st 2017 in
The standard drugs for osteoporosis are making bones weaker. Bisphosphonates are routinely given to the elderly and to cancer patients to help protect bones—but new research has discovered they are increasing the risks of a fracture.
The bones in people taking the drugs were showing microscopic cracks, researchers at Imperial College London discovered when they examined patients who had suffered a hip fracture.
Bisphosphonates are designed to slow the body's processes of removing ageing or damaged bone—but doctors have been concerned that patients were still suffering fractures even after taking the drugs a long time.
The researchers took samples from 16 hip-fracture patients who had been taking the drugs and compared them to samples from people of a similar age but who weren't prescribed bisphosphonates.
The bone samples from those taking the drugs were showing cracks that made the bones more fragile and liable to fracture.
The drugs are routinely given to treat osteoporosis and bone loss from chemotherapy in cancer patients.
http://wddty.com/news/2017/03/standard-osteoporosis-drug-is-making-bones-weaker.html
http://wddty.com/news/2017/03/standard-osteoporosis-drug-is-making-bones-weaker.html
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Bisphosphonates are a class of drugs that prevent the loss of bone mass, used to treat osteoporosis and similar diseases. They are the most commonly prescribed drugs used to treat osteoporosis.[1] They are called bisphosphonates because they have two phosphonate (PO(OH)
2) groups.
Adverse effects
Common
Oral bisphosphonates can cause upset stomach and inflammation and erosions of the esophagus, which is the main problem of oral N-containing preparations. This can be prevented by remaining seated upright for 30 to 60 minutes after taking the medication. Intravenous bisphosphonates can give fever and flu-like symptoms after the first infusion, which is thought to occur because of their potential to activate human γδ T cells.
Bisphosphonates, when administered intravenously for the treatment of cancer, have been associated with osteonecrosis of the jaw (ONJ), with the mandible twice as frequently affected as the maxilla and most cases occurring following high-dose intravenous administration used for some cancer patients. Some 60% of cases are preceded by a dental surgical procedure (that involve the bone), and it has been suggested that bisphosphonate treatment should be postponed until after any dental work to eliminate potential sites of infection (the use of antibiotics may otherwise be indicated prior to any surgery).[25]
A number of cases of severe bone, joint, or musculoskeletal pain have been reported, prompting labeling changes.[26]
Recent studies have reported bisphosphonate use (specifically zoledronate and alendronate) as a risk factor for atrial fibrillation in women.[27][28][29] The inflammatory response to bisphosphonates or fluctuations in calcium blood levels have been suggested as possible mechanisms.[28] Until now, however, the benefits of bisphosphonates, in general, outweigh this risk, although care must be taken in certain populations at high risk of serious adverse effects from atrial fibrillation (such as patients with heart failure, coronary artery disease, ordiabetes).[28] FDA has not yet confirmed a causal relationship between bisphosphonates and atrial fibrillation.[30][31]
Long-term risks[edit]
In large studies, women taking bisphosphonates for osteoporosis have had unusual fractures ("bisphosphonate fractures") in the femur (thigh bone) in the shaft (diaphysis or sub-trochanteric region) of the bone, rather than at the femoral neck, which is the most common site of fracture. However, these unusual fractures are extremely rare (12 in 14,195 women) compared to the common hip fractures (272 in 14,195 women), and the overall reduction in hip fractures caused by bisphosphonate far outweighed the unusual shaft fractures.[32] There are concerns that long-term bisphosphonate use can result in over-suppression of bone turnover. It is hypothesized that micro-cracks in the bone are unable to heal and eventually unite and propagate, resulting in atypical fractures. Such fractures tend to heal poorly and often require some form of bone stimulation, for example bone grafting as a secondary procedure. This complication is not common, and the benefit of overall fracture reduction still holds.[32][33] In cases where there is concern of such fractures occurring, teriparatide is potentially a good alternative because it does not cause as much damage as a bisphosphonate does by suppressing bone turnover.[34]
Three meta analyses have evaluated whether bisphosphonate use is associated with an increased risk of esophageal cancer. Two studies concluded that there was no evidence of increased risk.[35][36][37]
https://en.wikipedia.org/wiki/Bisphosphonate
https://en.wikipedia.org/wiki/Bisphosphonate
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Mayo Clin Proc. 2009 Jul; 84(7): 632–638.
PMCID: PMC2704135
Adverse Effects of Bisphosphonates: Implications for Osteoporosis Management
This article has been cited by other articles in PMC.
Abstract
Bisphosphonates are widely prescribed and highly effective at limiting the bone loss that occurs in many disorders characterized by increased osteoclast-mediated bone resorption, including senile osteoporosis in both men and women, glucocorticoid-associated osteoporosis, and malignancies metastatic to bone. Although they are generally well tolerated, potential adverse effects may limit bisphosphonate use in some patients. Optimal use of bisphosphonates for osteoporosis requires adequate calcium and vitamin D intake before and during therapy. The World Health Organization fracture risk assessment algorithm is currently available to determine absolute fracture risk in patients with low bone mass and is a useful tool for clinicians in identifying patients most likely to benefit from pharmacological intervention to limit fracture risk. This fracture risk estimate may facilitate shared decision making, especially when patients are wary of the rare but serious adverse effects that have recently been described for this class of drugs.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704135/
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Bisphosphonates
Bisphosphonates are widely prescribed and highly effective at limiting the bone loss that occurs in many disorders characterized by increased osteoclast-mediated bone resorption, including senile osteoporosis in both men and women, glucocorticoid-associated osteoporosis, and malignancies metastatic to bone. Although they are generally well tolerated, potential adverse effects may limit bisphosphonate use in some patients. Optimal use of bisphosphonates for osteoporosis requires adequate calcium and vitamin D intake before and during therapy. The World Health Organization fracture risk assessment algorithm is currently available to determine absolute fracture risk in patients with low bone mass and is a useful tool for clinicians in identifying patients most likely to benefit from pharmacological intervention to limit fracture risk. This fracture risk estimate may facilitate shared decision making, especially when patients are wary of the rare but serious adverse effects that have recently been described for this class of drugs.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704135/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704135/
What are Bisphosphonates
Bisphosphonates are drugs that inhibit mineralization or resorption of the bone by blocking the action of osteoclasts. Bisphosphonates are enzyme-resistant analogues of pyrophosphate, which normally inhibits mineralization in the bone. Their effect is dose dependent and they reduce the turnover of bone by inhibiting recruitment and promoting apoptosis of osteoclasts. Bisphosphonates are used to treat postmenopausal and glucocorticoid induced osteoporosis, Paget's disease of bone and malignant hypercalcemia. There are a few bisphosphonates available and one might work better for a particular condition, than the other.
List of Bisphosphonates:
Filter by:
Drug Name  ( View by: Brand | Generic ) | Reviews | Ratings | |
|---|---|---|---|
| Fosamax Plus D (Pro, More...) generic name: alendronate/cholecalciferol | 0 reviews | 9.5 | |
| Didronel (Pro, More...) generic name: etidronate | 0 reviews | 7.0 | |
| Zometa (Pro, More...) generic name: zoledronic acid | 17 reviews | 6.7 | |
| Reclast (Pro, More...) generic name: zoledronic acid | 35 reviews | 6.4 | |
| Boniva (Pro, More...) generic name: ibandronate | 28 reviews | 5.5 | |
| Aclasta (More...) generic name: zoledronic acid | 3 reviews | 5.2 | |
| Atelvia (Pro, More...) generic name: risedronate | 3 reviews | 4.7 | |
| Fosamax (Pro, More...) generic name: alendronate | 12 reviews | 4.7 | |
| Actonel (Pro, More...) generic name: risedronate | 15 reviews | 3.8 | |
| Actonel with Calcium (Pro, More...) generic name: calcium carbonate/risedronate | 1 review | 3.0 | |
| Aredia (Pro, More...) generic name: pamidronate | 0 reviews | 0.0 | |
| Binosto (Pro, More...) generic name: alendronate | 0 reviews | 0.0 | |
| Skelid (Pro, More...) generic name: tiludronate | 0 reviews | 0.0 | |
See also...
Medical conditions associated with bisphosphonates:
- Aseptic Necrosis
- Breast Cancer, Bone Metastases
- Heterotopic Ossification, Spinal Cord Injury
- Heterotopic Ossification, Total Hip Arthroplasty
- Hypercalcemia
- Hypercalcemia of Malignancy
- Osteolytic Bone Lesions of Multiple Myeloma
- Osteolytic Bone Metastases of Solid Tumors
- Osteoporosis
- Paget's Disease
- Prevention of Osteoporosis
Kannattiko osteoporoosilääkitys?
Hei,Minulla murtui lonkka viisi vuotta sitten. Se on taas toimintakykyinen, mutta silloin todettiin osteoporoosi. Olen sen jälkeen syönyt eri osteoporoosilääkkeitä sekä kalsiumia ja D-vitamiinia. Minulle tehtiin taas luuntiheysmittaus, jonka mukaan luut ovat samassa kunnossa kuin viisi vuotta sitten. Eli yhtään parannusta tilanteeseen ei ole tullut, vaikka lääkkeitä olen syönyt. Masentavaa. Kannattaako minun siis enää jatkaa lääkitystä?
Kiitos kysymyksestä! Pahoittelut lonkan puolesta, mutta hienoa kuulla, että lonkka saatiin korjattua.
Käypä hoito -suosituksessa sanotaan, että osteoporoosin hoidon tavoitteena on luunmurtumien esto. Eli sinunkin kohdallasi hoito on ollut tehokasta, jos uusia murtumia ei ole tullut.
Ymmärrän kuitenkin masennuksen syyn. Parempi tietenkin olisi, jos luuntiheys olisi lääkityksen aikana parantunut. Toisaalta voi miettiä asiaa siltä kannalta, kuinka paljon heikompi luuntiheys nyt olisi ilman lääkitystä. Eli ehkä lääkitys on pysäyttänyt luiden rappeutumisen.
Esimerkiksi bisfosfonaattihoidon pituudeksi on esitetty juuri viittä vuotta, jonka jälkeen lääkitys lopetetaan ja potilaan luuntiheyttä seurataan. Asia ei kuitenkaan ole näin yksinkertainen, vaan jokainen potilas hoidetaan yksilöllisesti.
Kalsiumin ja D-vitamiinin ottamista kannattaa ehdottomasti jatkaa. Niiden lisäksi luuston kannalta olisi hyvä harrastaa säännöllistä, luita kuormittavaa liikuntaa. Tupakoinnille taas on sanottava ehdoton ei.
Lääkityksen jatkamisesta kannattaa päättää yhdessä hoitavan lääkärin kanssa, mutta näillä tiedoilla en pitäisi otettua lääkettä turhanakaan.
http://www.healthberry.fi/kannattiko-osteoporoosilaakitys/
BISFOSFONAATTI, D-VITAMIINI, KALSIUM, LONKKAMURTUMA, LUU, LUUN MURTUMA, LUUNTIHEYDEN MITTAUS, OSTEOPOROOSI, OSTEOPOROOSILÄÄKE, OSTEOPOROOSIN EHKÄISY
http://www.healthberry.fi/kannattiko-osteoporoosilaakitys/
BISFOSFONAATTI, D-VITAMIINI, KALSIUM, LONKKAMURTUMA, LUU, LUUN MURTUMA, LUUNTIHEYDEN MITTAUS, OSTEOPOROOSI, OSTEOPOROOSILÄÄKE, OSTEOPOROOSIN EHKÄISY
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Tunnetuin osteoporoosilääke on nimeltään Fosamax. Muitakin on olemassa, mutta ne kaikki vaikuttavat samalla tavalla.
Luu ei ole kovaa kuin kivi kuten voisi luulla vaan luu on elävä elin joka muovautuu jatkuvasti rasitustilojen mukaan. Luu on jatkuvassa muutoksen prosessissa. Tässä muovautumisessa kaksi eri soluryhmää näyttelevät pääroolia. Toinen soluryhmä (osteoklastit) syövät luuta ja toinen (osteoblastit) muodostavat uutta luuta eli luussa vanhaa osaa poistetaan ja uutta rakennetaan tilalle.
Prosessi on jatkuva. Toimintojen tulee olla keskenään tasapainossa.
Prosessi on jatkuva. Toimintojen tulee olla keskenään tasapainossa.
Fosamax, joka kemialtaan kuuluu fosfonaattien ryhmään, mitä yhdisteitä käytetään myös tavallisissa puhdistusaineissa, ehkäisee osteoklastien toimintaa.
On todettu, että aine ei vain ehkäise osteoklastisolujen toimintaa vaan jopa tuhoaa niitä. Nerokas lääkeen keksijä on ajatellut tässä kohtaa niin, että jos luuta syövät solut tapetaan, niin luuta muodostavat solut jatkavat toimintaa ja luu vahvistuu.
Valitettavasti todellisuus ei ole näin yksinkertainen.
Luu on amorfista ainetta, mikä tarkoittaa, ettei se ole kivikovaa vaan joustavaa ainetta, jota voisi verrata vaikkapa kivikovaan kumiin kuten jääkiekkoon.
On todettu, että aine ei vain ehkäise osteoklastisolujen toimintaa vaan jopa tuhoaa niitä. Nerokas lääkeen keksijä on ajatellut tässä kohtaa niin, että jos luuta syövät solut tapetaan, niin luuta muodostavat solut jatkavat toimintaa ja luu vahvistuu.
Valitettavasti todellisuus ei ole näin yksinkertainen.
Luu on amorfista ainetta, mikä tarkoittaa, ettei se ole kivikovaa vaan joustavaa ainetta, jota voisi verrata vaikkapa kivikovaan kumiin kuten jääkiekkoon.
Kun luuta syövät solut tuhotaan muuttuu luu kivikovaksi kuten lasi. Jokainen ymmärtää, että lasi murtuu herkästi verrattuna kumiin.
Tämä ilmiö onkin todettavissa Fosamaxilla hoidetuilla potilailla. Osteoporoosilääkkeet aiheuttavat murtumia, jopa sellaisia mitä ei tapaa potilailla, joita ei ole lainkaan hoidettu millään lääkkeillä.
Tämä ilmiö onkin todettavissa Fosamaxilla hoidetuilla potilailla. Osteoporoosilääkkeet aiheuttavat murtumia, jopa sellaisia mitä ei tapaa potilailla, joita ei ole lainkaan hoidettu millään lääkkeillä.
Näin karua kieltään kertoo vimeisimmät tutkimukset .
http://www.etlehti.fi/keskustelu/2047/ketju/tiesitko_taman_osteoporoosilaakkeista_fosamax_ym
http://www.etlehti.fi/keskustelu/2047/ketju/tiesitko_taman_osteoporoosilaakkeista_fosamax_ym
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