Optimum duration and safety of long-term use of potent anti-resorptive medications in osteoporosis

Abstract

Anti-resorptive drugs are the most commonly used medications for treating metabolic bone diseases. These agents reduce the risk of osteoporosis fractures, control Paget's disease, hypercalcemia of malignancy and bone metastasis. However, administration of high doses or long-term use are associated with rare but serious adverse effects. Areas covered: Beyond 5 years of use, fracture reduction benefits of bisphosphonate and denosumab are minimal, while the incidence of serious adverse events increases. Thus the FDA recommends limiting treatment to less than 5 years. However, treating beyond 5 years with bisphosphonates or denosumab is appropriate in patients in whom the reduction of fracture benefits outweighs adverse effects. Detailed insight into safety and the duration of use of potent anti-resorptive agents are discussed. Expert commentary: Considering the safety and effectiveness, in patients with osteoporosis and Paget's disease of bone, the use of potent antiresorptive agents should be limited for five years and three years in patients with cancer to control the complications. An annual reassessment is recommended for patients with osteoporosis, and Paget's disease these agents to (a) assess overall health, adherence to medication, and objective measures of improvements; (b) exclude secondary causes of bone loss; and

Vitamin D Adequacy and Improvements of Comorbidities in Persons with Intellectual Developmental Disabilities

“…Nevertheless, as with other physiological phenomena, the goal should be to achieve the optimal necessary serum 25(OH)D levels to obtain the most benefit in body tissues to reduce vitamin D-deficiency associated disorders while minimizing potential, albeit rare, adverse effects [181]. Thus, aiming to achieve the middle of the suggested normal range (optimal level) (50 ng/mL) should provide the benefit of achieving serum 25(OH) D levels above 40 ng/mL in most persons with MCDD.…”

Physiology of Vitamin D—Focusing on Disease Prevention

“…Supra-pharmacologic doses of vitamin D administered at intervals of less than a month [ 222 , 223 , 224 ] could lead to negative clinical outcomes, such as increased falls and resulting fractures, as demonstrated in some improperly designed clinical trials [ 217 , 225 ]. Therefore, vitamin D supplements should be given at less-than-monthly intervals and preferably administered daily, especially in RCTs [ 226 ].…”