title: Treatment of osteoporosis in women intolerant of oral bisphosphonates.
abstract: In the past 15 years, oral bisphosphonate therapy has become the mainstay of pharmacological management in patients with osteoporosis. In the UK, alendronate is the drug of first choice, based on clinical efficacy data and cost. However, some patients are unable to take oral bisphosphonates for a number of reasons. In this article, we review the practical management of such cases, including strategies for monitoring adherence and switching to alternative oral agents (e.g. risedronate, strontium ranelate, raloxifene). In some cases, alternative parenteral agents may be considered, including intravenous bisphosphonates, parathyroid hormone therapies and denosumab. Specific concerns about safe prescribing are considered, when prescribing potent anti-resorptive medications, particularly relating to renal function and vitamin D deficiency. Finally, consideration is given to clinical risk factors, including aspects of lifestyle which may be modified to decrease fracture risk.
authors.affiliation: Musculoskeletal Unit, Freeman Hospital, Newcastle upon Tyne, UK. T.J.Aspray@Newcastle.ac.uk
authors.forename: Terry J
authors.initials: TJ
authors.lastname: Aspray
authors.forename: Roger M
authors.initials: RM
authors.lastname: Francis
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000069448:Denosumab; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004333:Drug Administration Routes; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control*; D006801:Humans; D007668:Kidney / Q000187:drug effects; D010024:Osteoporosis / Q000188:drug therapy*; D010281:Parathyroid Hormone / Q000627:therapeutic use; D010349:Patient Compliance; D014808:Vitamin D Deficiency / Q000150:complications
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D010281:Parathyroid Hormone; D000069448:Denosumab