This medicine is "specially used" to treat osteoporosis. It is only used once a year, and you can give yourself a break from time to time!

The endocrinology department recently admitted a "porcelain doll" - 55-year-old Ms. Zhang. When she got off the bus, her feet were unstable and her foot was bent 180 degrees. The hospital diagnosed her with a comminuted fracture. During her recovery, she sat on the bed and wanted to sit up with her hands, but she broke her hand again. She finally recovered, but recently she had back pain. A CT scan showed a vertebral fracture...

The doctor thought it was a brittle fracture and asked her to check her bone density. The results showed that her T value was less than -2.5, and she was diagnosed with severe osteoporosis. The doctor recommended that she choose bisphosphonates, which include alendronate sodium, which is taken orally once a week, and zoledronic acid, which is injected intravenously once a year. If she enters a drug holiday, she can temporarily stop taking the drug.

What kind of drugs are bisphosphonates? Why can they be given once a year? And with vacations?

The human body's "tofu dregs"

A fragility fracture is a fracture that occurs with only a minor trauma and is actually caused by a decrease in bone strength.

Bone strength is mainly determined by bone density. Bone density can be measured by dual-energy X-ray. The bone density level of postmenopausal women and men over 50 years old can be expressed by T value, and other people can be expressed by Z value. If the T value is ≤-2.5 or the Z value is ≤-2.0, osteoporosis can be diagnosed.

If we compare bone formation to building a house, then the house is constantly under construction and demolition. Generally speaking, bone formation and destruction are in a dynamic equilibrium. However, once the destruction exceeds the construction, it will lead to bone loss, and in the long run, osteoporosis will occur. The house built by osteoporosis patients becomes a "shoddy project".

Bisphosphonates that work hard

Bisphosphonates are the current mainstay of osteoporosis treatment, and their purpose is to combat the house-building destroyers, reduce bone destruction, and thus reduce bone loss.

Currently, there are two types of bisphosphonates on the market: oral bisphosphonates and intravenous bisphosphonates.

What are the differences between them? How should we choose and use them?

Oral bisphosphonates (alendronate)

Directions:

Take it in the morning on an empty stomach with at least 200-300 mL of water.

After taking the medicine, the patient should stand upright and refrain from eating or drinking for at least half an hour.

If you miss a dose, stop taking the medicine on that day and take one tablet the next morning. You must resume taking one tablet per week according to the originally scheduled date.

Contraindications:

Because oral bisphosphonates have local effects on the esophageal and gastric mucosa, they should not be taken by patients with conditions that may increase the residence time of the drug in the esophagus, such as achalasia, esophageal stenosis, esophageal varices, and Barrett's esophagus.

If the patient has contraindications to oral bisphosphonates or is unable to stand or sit upright for 30 minutes after taking the medication, intravenous bisphosphonates can be used.

Intravenous bisphosphonates (zoledronic acid)

As a third-generation bisphosphonate drug, zoledronic acid has a biological activity 10,000 times that of the first-generation drugs. It has stronger bone binding ability and longer-lasting effect. Therefore, a single injection can maintain the effect for one year.

Directions:

Patients should drink plenty of water before use.

The intravenous infusion time should be no less than 15 minutes.

Transient flu-like symptoms may occur after use and can be treated symptomatically.

Contraindications:

Check renal function before taking the medicine, as it is contraindicated in patients with severe renal insufficiency.

This drug can cause serious adverse reactions such as osteonecrosis of the mandible and is contraindicated in patients who have recently undergone dental surgery.

Hey, take a year off.

Bisphosphonates are not meant to be used continuously. As the saying goes, “Out with the old, in with the new.” The same is true for our bones, which need to be constantly renewed to stay in top shape. Therefore, the drugs also need to take a break.

Usually, oral alendronate sodium is taken for 5 years or intravenous zoledronic acid is taken for 3 years, and dual-energy X-ray is repeated. If the patient's T-score is greater than -2.5 or no new fractures occur during treatment, a drug holiday can be entered.

However, when the risk of fracture is still increasing, and dual-energy X-ray examination during follow-up shows that the decrease in bone density is greater than the minimum significant change in bone density during follow-up, or bone turnover markers are elevated, it is necessary to consider suspending the drug holiday and restarting anti-osteoporosis treatment.

The elderly and postmenopausal women need to pay attention to bone changes. If they feel any discomfort, they should seek medical attention in time and choose appropriate anti-osteoporosis drugs for treatment.