Denosumab: Hypocalcemia
PEARL: Denosumab carries risk of hypocalcemia particularly in those with low serum calcium, abnormal mineral metabolism, hypovitaminosis D, or advanced renal disease The body increases serum calcium levels primarily through the release of bone stores. …
Bisphosphonates: Holiday
The idea behind a bisphosphonate holiday is to reduce the chance of osteonecrosis of the jaw (ONJ) and atypical femur fractures (AFF) while not compromising the risk of an osteoporotic fracture (JCEM 2019 – bisphosphonate …
Bisphosphonates: Worsening BMD on therapy
PEARL: If the BMD is worsening (outside the margin of the least significant change), this should prompt a reevaluation of bisphosphonate therapy Common causes to consider: Medication nonadherence – oral agents have adherence rates of …
Bisphosphonates: BMD after initiation
There is no consensus on the optimal frequency of monitoring and preferred site to monitor (UpToDate – Guidelines for monitoring response to therapy) Recommendations range from against monitoring (American College of Physicians) to every one …
Bisphosphonates: Oral bisphosphonate adverse effects
Pearl: Oral bisphosphonates can cause erosive esophagitis, worsen GERD, and have low rates of adherence compared to other first line therapies. Oral bisphosphonates are associated with erosive esophagitis and may worsen GERD especially in those …
Bisphosphonates: eGFR cutoffs
PEARL: Bisphosphonates are not recommended for patients with severe renal impairment! FDA has contraindications and warning on renal impairment for bisphosphonates: Alendronate not recommended for patients with creatinine clearance <35 ml/min (link to FDA package …
Osteoporosis: Bisphosphonates
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Osteoporosis: Denosumab
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Osteoporosis: Teriparatide or Abaloparatide
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Osteoporosis: Romosozumab
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