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OsteoporosisDrugs
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> risk of atypical fractures (uncommon ) with all treatment .... check risk every 5 years and think ... ? drug holiday ?? ''bisphosphonates'' alendronate, risedronate, etidronate - all for post men and steroid induced osteoporosis all reduce vertebral and non-vertebral ~ but etidronate less effective with hips ibadronate - once monthly oral gi se can be a problem use avoid with ppi as not absorbed zolendronate ... yearly infusion beware jaw osteonecrosis off license at 4 mg .... ''calcium and vit D '' cvs risk not a problem with vit d and ca ?? ? take diet history 3 portions of dairy per day little evidence of effect in general population ? useful in elderly housebound .... ''raloxifene'' (SERM) shown to prevent bone loss and reduce vertebral fractures but not non-vertebral # in bone density - spine and femur ?worsen menopausal Sx Inc risk VTE dec risk breast ca ''strontium'' dual action (on blasts and clasts) dvt and cvs risks so don't use unless from secondary care skin reactions - Stephen Johnson ''denosumab'' ... twice a year sub cut ... se cellulitis inhibits RANK ligand which inhibits osteoclasts effective and well tolerated ''Teriparatide'' recombinant parathormone v good at inc bone density - role in osteoporosis not yet defined ''HRT'' dec risk vertebral and non-vertebral # inc CVS and breast ca - only use for vasomotor Sx ''Hip protectors'' significantly reduce hip fractures in nursing home patients compliance is a problem ''Falls risk assessment'' no evidence to suggest reduced fracture rates but do reduce rate of falls - so consider in high risk
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