Pharmaceutical management of bone catabolism: the bisphosphonates

  • E J Raubenheimer Ampath Histopathology Laboratory
  • C E E Noffke Katholieke Universiteit Leuven
  • L B Lemmer Ampath Histopathology Laboratory
  • T Slavik Ampath Histopathology Laboratory
  • W F P Van Heerden University of Pretoria
  • H D Miniggio Sefako Makgatho Health Sciences University
Keywords bisphosphonates, osteoporosis, bone metastases, Paget’s disease of bone, glucocorticoid bone disease, osteogenesis imperfecta, jaw bone necrosis

Abstract

Background: Conditions associated with catabolism of bone are common and progress sub-clinically with devastating skeletal consequences. Over the past two decades, bisphosphonates have become increasingly popular for the preventative management of the skeleton in these conditions.


Methods: Recent literature pertaining to the mechanisms of action, clinical indications and complications of bisphosphonate therapy was retrieved using Google Scholar and Pubmed.


Aims of study: To provide an overview of the mechanisms of action, indications, contraindications and complications of the bisphosphonates available for clinical use in South Africa.


Results: Despite the availability of alternative management regimens, bisphosphonates remain the pharmaceuticals of choice for the management of hypercalcaemia and generalised catabolic skeletal disorders such as osteoporosis, skeletal metastatic disease, Paget’s disease of bone, glucocorticoid bone disease and osteogenesis imperfecta. Although adverse complications such as tachycardia, bowel and oesophageal irritation, pain, jawbone necrosis and atypical femur fractures are well documented, information remains limited on the long-term effects of bisphosphonate therapy on skeletal health. This manuscript provides an update on the mechanisms of action, principles applied to the selection of the most appropriate management regimen, monitoring of the response and complications of the bisphosphonates marketed in South Africa.


Level of evidence: Level 5

Author Biographies

E J Raubenheimer, Ampath Histopathology Laboratory

MChD, PhD, DSc; Ampath Histopathology Laboratory, Pretoria, Department of Oral Pathology and Oral Biology, University of Pretoria, South Africa, OMFS IMPATH, Katholieke Universiteit Leuven, Belgium

C E E Noffke, Katholieke Universiteit Leuven

MSc; OMFS IMPATH, Katholieke Universiteit Leuven, Belgium

L B Lemmer, Ampath Histopathology Laboratory

MBChB, M Prax Med, M Med (Path), FCFP (SA); Ampath Histopathology Laboratory, Pretoria, South Africa

T Slavik, Ampath Histopathology Laboratory

MBChB, MMed(Anat Path); Ampath Histopathology Laboratory, Pretoria, South Africa

W F P Van Heerden, University of Pretoria

MChD, PhD, DSc; Department of Oral Pathology and Oral Biology, University of Pretoria, Pretoria, South Africa

H D Miniggio, Sefako Makgatho Health Sciences University

BDS, MScMed (Bioethics and Health Law); Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa

Published
2019-01-21
How to Cite
RAUBENHEIMER, E J et al. Pharmaceutical management of bone catabolism: the bisphosphonates. South African Orthopaedic Journal, [S.l.], p. 47-52, jan. 2019. ISSN 2309-8309. Available at: <http://journal.saoa.org.za/index.php/saoj/article/view/242>. Date accessed: 25 june 2019.
Section
General Articles

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