RDTC Safer Medication Use – Bisphosphonates

· Regional Drug and Therapeutics Centre

Safer Medication Use is a new bulletin series developed with the Yellow Card Centre (Northern and Yorkshire). This issue highlights the safety aspects of oral and IV bisphosphonates. The following is an abstract taken directly from the document.

Gastrointestinal adverse effects are common with all bisphosphonates. With the exception of zoledronic acid, all have been reported to cause oesophageal ulceration, the incidence of which is minimized by adherence to strict administration guidelines. No difference in the risk of serious upper gastrointestinal reactions has been demonstrated between alendronic acid and risedronate.

Atrial fibrillation has been associated with zoledronic acid and possibly alendronic acid; further investigation into a link between bisphosphonates and atrial fibrillation is ongoing.

Osteonecrosis of the jaw has been reported with bisphosphonates prescribed for osteoporosis, which may be precipitated by dental surgery; the degree of risk in such patients is uncertain and extra vigilance is warranted.

All bisphosphonates can cause severe musculoskeletal pain, which generally resolves on discontinuation.

A paucity of data in patients with renal dysfunction means all bisphosphonates should be used with caution in severe renal impairment.