Monitoring & Managing Side Effects

Managing osteoporosis involves not only selecting the appropriate medication but also monitoring for and addressing any potential side effects. Most patients tolerate osteoporosis treatments well, but side effects can occur, necessitating careful monitoring and timely intervention.

Monitoring and managing side effects ensures patients can continue osteoporosis treatment with confidence, balancing benefits, and risks.

For oral bisphosphonates like alendronate and risedronate, common side effects include gastrointestinal issues such as heartburn and oesophageal irritation. These can often be managed by following administration guidelines, such as taking the medication on an empty stomach with water and remaining upright for 30 minutes afterward. The bioavailability of oral bisphosphonates is extremely low, and co-administration with food can further reduce absorption significantly.

Zoledronate, administered as an IV infusion, may cause flu-like symptoms, particularly after the first dose. Approximately 30% of patients experience these symptoms within a few days, but they typically diminish with subsequent infusions. Symptoms can often be alleviated by taking paracetamol following the infusion. If the symptoms are more severe, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can be added or used as an alternative. A study from Auckland demonstrated that a 3-day course of dexamethasone substantially reduces the acute phase response following zoledronate infusion. Post-infusion reactions tend to significantly lessen or may not occur after the next dose.

Denosumab may cause injection site reactions and, rarely, hypocalcaemia. Regular monitoring of calcium levels is essential, particularly in patients with renal impairment.

For patients on long-term bisphosphonates or denosumab, rare but serious side effects like osteonecrosis of the jaw and atypical femur fractures may occur. Implementing drug holidays after 3 to 5 years of continuous bisphosphonate use can mitigate these risks.

Close monitoring and individualised adjustments ensure that the benefits of treatment outweigh the risks, enabling patients to continue their therapy with confidence.