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Osteoporosis (Drug induced bone disease (alcohol, Levothyroxine-->…

- - - - decrease cancer risk in uterus in breast
    - - adverse effects
        
        hot flashes
        
        not useful for treating menopausal symptoms
        
        leg cramps
        
        increased risk of VTE and stroke
        
        Drug interactions
        
        Cholestyramine
        
        Warfrin
        
        cardiovascular
        
        no increased risk
  - - - can be given weekly or monthly
      - take with 6-8 oz. of plain water first thing in the AM
      - after administration, 30 mins must pass before eating/drinking, taking other meds or laying down
      - give for 5 years and then give a drug holiday and then reevaluate
    - - significant GERD(only a precaution, give with PPI)
      - renal insufficiency (ClCr <30 mL/min)
      - Esophageal abnormalities(strictures)
    - - Zoledronic acid
        
        IV once a year
      - Alendronate
        
        PO weekly
        
        Cheap
      - Risedronate
        
        PO weekly or monthly
      - PO monthly
        
        Ibandronate
    - - Atrial fibrillation
      - Atypical fractures
        
        caused by severely suppressed bone turnover
        
        accumulated microdamage
      - Osteonecrosis
      - Muscluloskeletal pain
      - Ocular inflammation
  - - - monoclonal antibody for RANKL
      - very effective
      - SQ every 6 months
      - well tolerated
      - When stopped there is a severe increase in Osteoclast activity
        
        Do not stop without a blan in place to prevent the rapid rebound
      - expensive
- - - - 1000 mg daily goal
    - - 1200 mg daily goal
- - - - continuous ing increases osteoclast activity and bone resorption
    - - increases osteoblast activity
    - - Fracture during bisphosphate therapy