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Lookup NU author(s): Dr Terry AsprayORCiD,
Emeritus Professor Roger Francis
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In the past 15 years, oral bisphosphonate therapy has become the mainstay of pharmacological management in patients with osteoporosis. In the UK, alendronate is the drug of first choice, based on clinical efficacy data and cost. However, some patients are unable to take oral bisphosphonates for a number of reasons. In this article, we review the practical management of such cases, including strategies for monitoring adherence and switching to alternative oral agents (e.g. risedronate, strontium ranelate, raloxifene). In some cases, alternative parenteral agents may be considered, including intravenous bisphosphonates, parathyroid hormone therapies and denosumab. Specific concerns about safe prescribing are considered, when prescribing potent anti-resorptive medications, particularly relating to renal function and vitamin D deficiency. Finally, consideration is given to clinical risk factors, including aspects of lifestyle which may be modified to decrease fracture risk. (C) 2011 Elsevier Ireland Ltd. All rights reserved.
Author(s): Francis RM; Aspray TJ
Publication type: Review
Publication status: Published
Print publication date: 10/11/2011
ISSN (print): 0378-5122
ISSN (electronic): 1873-4111
Publisher: ELSEVIER IRELAND LTD
PubMed id: 22079368