From the Guidelines
Bisphosphonate therapy, such as Fosamax (Alendronate), is contraindicated in patients with abnormalities of the esophagus, inability to stand or sit upright for at least 30 minutes, hypersensitivity to any component of the product, and hypocalcemia. When considering bisphosphonate therapy, it is crucial to evaluate the patient's overall health and potential contraindications.
Key Contraindications
- Abnormalities of the esophagus, as noted in the study 1, pose a significant risk due to the potential for esophageal irritation.
- Inability to stand or sit upright for at least 30 minutes, also mentioned in 1, is a contraindication to prevent esophageal irritation.
- Hypersensitivity to any component of the bisphosphonate product, as indicated in 1, is an absolute contraindication.
- Hypocalcemia, referenced in 1, should be corrected before initiating therapy to prevent further lowering of calcium levels. Other considerations include:
- Patients at increased risk of aspiration should not receive alendronate solution, as per 1.
- Venous thromboembolism, pregnancy, and breastfeeding are contraindications for certain medications like Raloxifene (Evista), as noted in 1.
- Hypersensitivity to teriparatide or any of its excipients is a contraindication for Teriparatide (recombinant human parathyroid hormone 1-34; Forteo), as mentioned in 1.
- Hypocalcemia is also a contraindication for Denosumab (Prolia), as indicated in 1. It is essential to carefully evaluate each patient's condition and medical history before initiating bisphosphonate therapy, considering the potential risks and benefits, as outlined in the study 1.
From the FDA Drug Label
- 2 Mineral Metabolism Hypocalcemia must be corrected before initiating therapy with alendronate sodium [see Contraindications (4)].
Although the text does not explicitly state the contraindications in this section, it does mention to see Contraindications (4) for more information about hypocalcemia.
The FDA drug label does mention that Hypocalcemia must be corrected before initiating therapy with alendronate sodium, and to see the Contraindications section for more information. However, the Contraindications section itself is not provided in the given text.
- The text does provide some warnings and precautions for the use of alendronate sodium, but it does not explicitly state all the contraindications.
- It is important to consult the full drug label, including the Contraindications section, for complete information on the contraindications for alendronate sodium therapy 2.
From the Research
Contraindications for Bisphosphonate Therapy
The following are contraindications for bisphosphonate therapy, including medications like Fosamax (Alendronate):
- Severe renal impairment (creatinine clearance <30 or <35 mL/min) 3
- Hypocalcemia, including symptomatic hypocalcemia and severe hypocalcemia 4, 5
- Renal dysfunction, including acute renal failure and pre-existing renal impairment 4, 5
- Vitamin D deficiency, which should be corrected prior to treatment to reduce the risk of hypocalcemia 4, 5
- Parathyroid gland dysfunction, which should be evaluated before bisphosphonate treatment 5
Precautions for Bisphosphonate Therapy
The following precautions should be taken when using bisphosphonate therapy:
- Monitoring of serum calcium and renal function during treatment 4, 3, 5
- Correction of vitamin D deficiency prior to treatment 4, 5
- Supply of vitamin D and calcium during treatment with bisphosphonates 5
- Caution in patients with myeloma and renal impairment 4
- Caution in elderly, frail, osteoporotic patients with renal impairment 3
Potential Risks of Bisphosphonate Therapy
The following potential risks are associated with bisphosphonate therapy:
- Upper gastrointestinal discomfort for oral bisphosphonates 6
- Acute phase reactions for intravenous forms 6
- Hypocalcemia and renal injury, although rare 6
- Severe musculoskeletal pain and ocular events 6
- Osteonecrosis of the jaw, more common in cancer sufferers who receive high doses of intravenous bisphosphonates 6
- Atypical femoral fractures, very rare compared with osteoporotic fractures that bisphosphonates prevent 6