Journal
CALCIFIED TISSUE INTERNATIONAL
Volume 89, Issue 2, Pages 91-104Publisher
SPRINGER
DOI: 10.1007/s00223-011-9499-8
Keywords
Osteoporosis; Adverse drug reaction; Drug-drug interaction; Bisphosphonate; Denosumab; SERM; Strontium ranelate; Teriparatide
Categories
Funding
- Servier
- Novartis
- Negma
- Lilly
- Wyeth
- Amgen
- GlaxoSmithKline
- Roche
- Merckle
- Nycomed
- NPS
- Theramex
- UCB
- Merck Sharp and Dohme
- Rottapharm
- IBSA
- Genevrier
- Teijin
- Teva
- Ebewee Pharma
- Zodiac
- Analis
- Novo-Nordisk
- Bristol Myers Squibb
- Eli Lilly
- Merck
- Ono
- Sanofi-Aventis
- Warner Chilcott
- Nestle
- Danone
- ViiV
- Chugai
- GE
- Glaxo
- MSD
- Wyeth/Pfizer
- Daiichi-Sankyo
- Merck Sharp Dohme
- Abiogen, Italy
- Amgen, USA
- Amgen, Switzerland
- Amgen, Belgium
- Bayer, Germany
- Besins-Iscovesco, France
- Biosintetica, Brazil
- Boehringer Ingelheim, UK
- Celtrix, USA
- D3A, France
- European Federation of Pharmaceutical Industry and Associations, (EFPIA) Brussels
- Gador, Argentina
- General Electric, USA
- GSK, UK
- GSK, USA
- Hologic, Belgium
- Hologic, USA
- Kissei, Japan
- Leiras, Finland
- Leo Pharma, Denmark
- Lilly, USA
- Lilly, Canada
- Lilly, Japan
- Lilly, Australia
- Lilly, UK
- Merck Research Labs, USA
- Merlin Ventures, UK
- MRL, China
- Novartis, Switzerland
- Novartis, USA
- Novo Nordisk, Denmark
- Nycomed, Norway
- Ono, UK
- Ono, Japan
- Organon, Holland
- Parke-Davis, USA
- Pfizer USA
- Pharmexa, Denmark
- Procter and Gamble, UK
- Procter and Gamble, USA
- ProStrakan, UK
- Roche, Germany
- Roche, Australia
- Roche, Switzerland
- Roche, USA
- Rotta Research, Italy
- Sanofi-Aventis, USA
- Schering, Germany
- Schering, Finland
- Servier, France
- Servier, UK
- Shire, UK
- Solvay, France
- Solvay, Germany
- Strathmann, Germany
- Tarsa Therapeutics, US
- Tethys, USA
- Teijin, Japan
- Teva, Israel
- UBS, Belgium
- Unigene, USA
- Warburg-Pincus, UK
- Warner-Lambert, USA
- Wyeth, USA
- Alliance for Better Bone Health
- Medical Research Council [U1475000001, MC_UP_A620_1014] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0508-10082] Funding Source: researchfish
Ask authors/readers for more resources
The pharmacological management of disease should involve consideration of the balance between the beneficial effects of treatment on outcome and the probability of adverse effects. The aim of this review is to explore the risk of adverse drug reactions and drug-drug interactions with treatments for postmenopausal osteoporosis. We reviewed evidence for adverse reactions from regulatory documents, randomized controlled trials, pharmacovigilance surveys, and case series. Bisphosphonates are associated with gastrointestinal effects, musculoskeletal pain, and acute-phase reactions, as well as, very rarely, atrial fibrillation, atypical fracture, delayed fracture healing, osteonecrosis of the jaw, hypersensitivity reactions, and renal impairment. Cutaneous effects and osteonecrosis of the jaw are of concern for denosumab (both very rare), though there are no pharmacovigilance data for this agent yet. The selective estrogen receptor modulators are associated with hot flushes, leg cramps, and, very rarely, venous thromboembolism and stroke. Strontium ranelate has been linked to hypersensitivity reactions and venous thromboembolism (both very rare) and teriparatide with headache, nausea, dizziness, and limb pain. The solidity of the evidence base depends on the frequency of the reaction, and causality is not always easy to establish for the very rare adverse reactions. Drug-drug interactions are rare. Osteoporosis treatments are generally safe and well tolerated, though they are associated with a few very rare serious adverse reactions. While these are a cause for concern, the risk should be weighed against the benefits of treatment itself, i.e., the prevention of osteoporotic fracture.
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