Endocrine system

Question 1

What are the MHRA alerts for bisphosphonates

Answer 1

• Atypical femoral fracture have been reported in patients receiving long term bisphosphonate treatment (5 or more years) - patients advised to report hip, joint or groin pain during treatment.
• Osteonecrosis of the jaw - increased risk with IV bisphosphonate treatment.
• osteonecrosis of the external auditory canal

Question 2

Contraindications for Alendronic acid

Answer 2

Abnormalities of the oesophagus, hypocalcaemia, and factors which delay emptying of gut

Question 3

cautions with alendronic acid

Answer 3

Active GI bleed, dysphagia, gastritis, history of ulcers,

Question 4

Avoid taking alendronic acid in CrCl below….

Answer 4

35ml/min

Question 5

Specific administration instructions for oral bisphosphonates?

Answer 5

swallowed whole, doses should be taken with plenty of water whilst sat upright or standing and should remain upright for 30 mins after dose.
Should be taken on an empty stomach ideally 30 mins before breakfast and other medications.

Question 6

Mechanism of action of bisphosphonates

Answer 6

slows the rate of bone bone growth and dissolution and therefore reducing the rate of bone turnover