Rare adverse effects of bisphosphonate therapy

• Published in: Current opinion in endocrinology, diabetes, and obesity Vol. 26; no. 6; pp. 335 - 338
• Main Authors: Ilyas, Zubair, Camacho, Pauline M.
• Format: Journal Article
• Language: English
• Published: England Wolters Kluwer Health, Inc. All rights reserved 01-12-2019
• Subjects: Bisphosphonate-Associated Osteonecrosis of the Jaw - epidemiology; Bisphosphonate-Associated Osteonecrosis of the Jaw - prevention & control; Bone Density - drug effects; Bone Density Conservation Agents - administration & dosage; Bone Density Conservation Agents - adverse effects; Diphosphonates - administration & dosage; Diphosphonates - adverse effects; Drug Administration Schedule; Drug-Related Side Effects and Adverse Reactions - epidemiology; Drug-Related Side Effects and Adverse Reactions - prevention & control; Femoral Fractures - chemically induced; Femoral Fractures - epidemiology; Femoral Fractures - therapy; Humans; Incidence; Patient Selection; Preventive Medicine - methods; Preventive Medicine - trends
• ISSN: 1752-296X; 1752-2978
• DOI: 10.1097/MED.0000000000000501

To give an update on the latest developments regarding rare adverse effects of bisphosphonate therapy.
Recent studies covering osteonecrosis of the jaw (ONJ) and atypical femoral fractures (AFFs) provided several updates to the literature. Identification of ONJ in large population databases is a challenge but based on one systematic review, the ICD-10 diagnosis code K10.2 (inflammatory conditions of the jaw) seems to be the most commonly used code for this condition. Duration of bisphosphonate therapy was determined to be an important predictor of AFFs. Appropriate duration of therapy followed by a timely drug holiday was shown to be the best strategy for improving bone mineral density and reducing fracture risk, while minimizing risk of rare adverse effects of therapy. The utility of bone turnover markers as a monitoring tool during drug holidays needs to be further investigated.
ONJ and AFFs are two of the rare adverse effects associated with bisphosphonate therapy. Population-level trends of bisphosphonate use suggest a decline in prescriptions, pointing to broad fears of these side effects. Careful patient evaluation, duration of bisphosphonate therapy, and use of drug holidays can help limit any risk associated with therapy.