Examples

• PO: Alendronate, Risedronate
• IV: Zoledronic acid (can be used for Cirrhosis Patient) , Pamidronate

Efficacy

Side effects:

• PO only
  • GERD
  • GIB - GI Bleeding
• IV only
  • first 3 days: Flu-like symptoms → Acetaminophen (Tylenol®)
  • mild Hypocalcemia ↓ Ca (< 2.2)
    • Esp. with CKD and Calcitriol (1,25 VD) deficiency
  • Acute CKD (rare)
• Both
  • AFF - Atypical Femoral Fracture
  • !ONJ - Osteonecrosis of the Jaw
  • Myalgia

MOA:

• Induce apoptosis of osteoclast

  

Admin:

• PO (Alendronate, Risedronate) has low adherence rate (30%) due to side-effect profile
• Switch to IV (Zoledronic acid) → Q12 mon.
• drug holiday (duration: 3 yr) in 3-6 yrs to avoid AFF