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Adverse reactions and drug-drug interactions in the management of women with postmenopausal osteoporosis
Rizzoli, Rene Reginster, Jean-Yves Boonen, Steven Bréart, Gérard Diez-Perez, Adolfo Felsenberg, Dieter Kaufman, Jean-Marc Kanis, John A. Cooper, Cyrus
Rizzoli, Rene
Reginster, Jean-Yves
Boonen, Steven
Bréart, Gérard
Diez-Perez, Adolfo
Felsenberg, Dieter
Kaufman, Jean-Marc
Kanis, John A.
Cooper, Cyrus
Abstract
The pharmacological management of disease should involve consideration of the balance between the beneficial effects of treatment on outcome and the probability of adverse effects. The aim of this review is to explore the risk of adverse drug reactions and drug–drug interactions with treatments for postmenopausal osteoporosis. We reviewed evidence for adverse reactions from regulatory documents, randomized controlled trials, pharmacovigilance surveys, and case series. Bisphosphonates are associated with gastrointestinal effects, musculoskeletal pain, and acute-phase reactions, as well as, very rarely, atrial fibrillation, atypical fracture, delayed fracture healing, osteonecrosis of the jaw, hypersensitivity reactions, and renal impairment. Cutaneous effects and osteonecrosis of the jaw are of concern for denosumab (both very rare), though there are no pharmacovigilance data for this agent yet. The selective estrogen receptor modulators are associated with hot flushes, leg cramps, and, very rarely, venous thromboembolism and stroke. Strontium ranelate has been linked to hypersensitivity reactions and venous thromboembolism (both very rare) and teriparatide with headache, nausea, dizziness, and limb pain. The solidity of the evidence base depends on the frequency of the reaction, and causality is not always easy to establish for the very rare adverse reactions. Drug–drug interactions are rare. Osteoporosis treatments are generally safe and well tolerated, though they are associated with a few very rare serious adverse reactions. While these are a cause for concern, the risk should be weighed against the benefits of treatment itself, i.e., the prevention of osteoporotic fracture.
Keywords
Osteoporosis, Adverse drug reaction, Drug–drug interaction, Bisphosphonate, Denosumab, SERM, Strontium ranelate, Teriparatide
Date
2011
Type
Journal article
Journal
Calcified Tissue International
Book
Volume
89
Issue
2
Page Range
91-104
Article Number
ACU Department
Mary MacKillop Institute for Health Research
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
Open access
License
File Access
Open
Notes
© The Author(s) 2011. This article is published with open access at Springerlink.com