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The Capital Region of Denmark - a part of Copenhagen University Hospital
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Safety issues with bisphosphonate therapy for osteoporosis

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  1. Development of semiquantitative ultrasound scoring system to assess cartilage in rheumatoid arthritis

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  2. Elevated faecal calprotectin is linked to worse disease status in axial spondyloarthritis: results from the SPARTAKUS cohort

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  3. Adjustment of the multi-biomarker disease activity score to account for age, sex and adiposity in patients with rheumatoid arthritis

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  1. Duration of hyperthyroidism and lack of sufficient treatment are associated with increased cardiovascular risk

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  2. Over- and Under-Treatment of Hypothyroidism Is Associated with Excess Mortality: A Register-Based Cohort Study

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  3. Women's lived experiences of learning to live with osteoporosis: a longitudinal qualitative study

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Randomized controlled trials have demonstrated the efficacy of bisphosphonates (BP) in improving BMD and reducing fracture risk. Various safety issues that were not noted in clinical trials have, however, now emerged with post-marketing surveillance and increasing clinical experience. The risk of atypical femoral fracture could increase with long-term use of BP, although absolute risk is very small, particularly when balanced against benefits. A drug holiday should be considered after 5 years of treatment for patients at low risk of fracture, although there is no official recommendation regarding this to guide clinicians. Osteonecrosis of the jaw from low-dose BP used for osteoporosis is very rare, and mainly a complication with high-dose i.v. BP used in oncology. The risk of atrial fibrillation too is negligible, and a definite link cannot be established between BP and oesophageal cancer. BP should be avoided in patients with severe renal impairment and during pregnancy and lactation because of limited safety data. Further epidemiological and clinical data are required to establish safety of BP in long-term users (>5 years) and provide evidence-based management.

Original languageEnglish
JournalRheumatology (Oxford, England)
Volume53
Issue number1
Pages (from-to)19-31
Number of pages13
ISSN1462-0324
DOIs
Publication statusPublished - Jan 2014

    Research areas

  • Bone Density Conservation Agents, Diphosphonates, Humans, Osteoporosis, Osteoporotic Fractures, Treatment Outcome

ID: 44258877