Osteoporosis Treatment by Residronate its dose in Postmenopausal osteoporosis

The drug for treatement of osteoporosis?? Ans: Bisphosphonates.  Mechanism of action of Bisphosphonates?  Ans: Bisphosphonates block bone resorption. Bisphosphonates bind strongly to the hydroxyapatite in the bone and interferes with osteoclasts, which are the bone cells that break down bone. The bisphosphonate molecules are incorporated into newly formed bone as they are analogs of pyrophosphate. Compared to other drugs, bisphosphonates stay in the body a very long time. Most drugs are excreted or metabolized by the body in a day or two. Bisphosphonates stay in the body for years through cycles of bone absorption. 

 

·        Bisphonates:--Most are taken orally, as a pill, either once a day or once a week. Bisphosphonates can be given intravenously 5 mg IV injection performed by infusion clinic once yearly.

         Such formulations are available for patients who cannot tolerate oral bisphosphonates. Some patients cannot sit upright for 30 to 60 minutes which is a requirement for some drugs. The bisphosphonate zoledronate can be administered through a patch.

 

 

 They have been widely used for years and although there can be side effects; the medical profession considers them generally safe and effective. Bisphosphonates are employed for:

·        treatment and prevention of postmenopausal osteoporosis

·        treatment to increase bone mass in men with osteoporosis

·        treatment and prevention of glucocorticoid induced osteoporosis

·        treatment of Paget’s disease

·        prevention of Skeletal Related Events (bone problems caused by cancer metastasis)

·        treatment of the hypercalcemia of malignancy

Side Effects

Non-approved but known (off label) uses

·        Vitamin D overdose

·        Osteoporosis caused by spinal injury.

Fosamax with D (alendronate with Vitamin D) manufactured by Merck

Dosage and Forms:

·        once weekly – 70mg/5,600U tablet

·        once weekly - 70mg/2,800U tablet

Actonel (risedronate) manufactured by Procter and Gamble / Sanofi-Aventis .The patent expired in 2011 and generic forms are now available. Dosage and Forms:
5mg, 35mg, 75mg and 150mg tablet

·        5mg tablet daily or

·        35mg tablet weekly or

·        75mg tablet taken on 2 consecutive days one time each month or

·        150mg tablet monthly

Non-approved but known (off label) uses

·        Hypercalcemia

·        Bone Cancer or Bone Metastases

Residronate: Is dispensed as Resical kit (otsira) –The small tab of Residronate have to be taken in empty stomach with 200 ml of water and she should not lie down for 1 hr. The other tablets in the kit are Calcium tab  1 tab BD to be consumed on  week days.

A similar product in Kit  formulations are available in the name of Xtra Cal srong Kit(Pulse). Risofos Kit (Cipla) Approx cost 100/- per Kit. The pink tab t be taken on Sunday morning as described and rest calcium tablets to e taken n BD schedule  calcium tablets . May be supplemented by Vit D if deficient.

 

 

 

Actonel with Calcium (risedronate with calcium)

Dosage and Forms:
Blister Package containing one (1) 35mg Actonel and six (6) 1250mg calcium carbonate tablets
o Actonel taken on day 1 and calcium taken on days 2 - 7

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The generic ames are .

·        Alendronate (Fosamax)

·        Alendronate plus Vitamin D.

·        Risedronate (Actonel)

·        Risedronate plus Calcium.

·        Ibandronate (Boniva)

·        zoledronic acid (Reclast, Zometa)

·        Etidronate (Didronel)

·        Pamidronate (Aredia)

What is Hydroxyapatite? Ans:    Hydroxyapatite is a calcium phosphorus compound that makes up about half of bone mass.

 

Alendronate (Fosamax), developed by Merck

Market Share and Sales:
Over 10 million prescriptions for alendronate were written in the US in 2016. Merck's patent expired more than a decade ago. Generic alendronate from other manufacturers now domainates the market.

Dosage and Forms:

10mg and 70mg tablet

·        10mg tablet daily or

·        70mg tablet weekly