Oral bisphosphonates (i.e., alendronate) are commonly used to treat osteoporosis, and proper administration is one of the most important concepts for the NAPLEX exam. These medications must be taken first thing in the morning on an empty stomach with a full glass of plain water only. Patients must remain upright for at least 30 minutes after dosing, or 60 minutes for ibandronate (excellent board exam nugget), and avoid food, drinks, or other medications during that time to reduce the risk of esophageal irritation and ensure adequate absorption. Incorrect administration is a frequent cause of treatment failure and adverse effects.
Another key point is that oral bisphosphonates have extremely low bioavailability and are highly susceptible to drug and food interactions. Calcium, iron, magnesium, antacids, dairy products, and multivitamins can significantly reduce absorption and should be taken later in the day, well separated from the bisphosphonate dose. These supplements bind oral bisphosphonates and reduce drug concentrations, which leads to a lack of efficacy.
Although uncommon, serious adverse effects are heavily tested and clinically important. Osteonecrosis of the jaw and atypical femur fractures have been associated with long-term bisphosphonate use, making dental health and duration of therapy essential counseling points. Patients should maintain good oral hygiene and ideally complete invasive dental procedures before initiation. Therapy duration should be reassessed after three to five years, as some low-risk patients may benefit from a drug holiday, while higher-risk patients may require continued treatment.
Are you looking to test your knowledge on osteoporosis? Be sure to check out this crossword puzzle!
0 Comments