Drugs Affecting Bone Metabolism

Calcitonin and parathyroid hormone

CALCITONIN (SALMON)/SALCATONIN:

Indications: Calcitonin is licensed for the treatment of Paget’s disease of bone. It can also be used in the prevention and treatment of postmenopausal osteoporosis.

Contraindications: Hypocalcemia.

Dose and Administration: Hypercalcaemia of malignancy, an adult over 18 years, by subcutaneous or intramuscular injection, and 100 units every 6–8 hours adjusted according to response; max. 400 units every 6–8 hours; in severe or emergency cases, by intravenous infusion, up to 10 units/kg over at least 6 hours. Postmenopausal osteoporosis to reduce risk of vertebral fractures, intranasally, 200 units (1 spray) into one nostril daily, with dietary calcium and vitamin D supplements. Prevention of acute bone loss due to sudden immobility, adult over 18 years, by subcutaneous or intramuscular injection, 100 units daily in 1–2 divided doses for 2–4 weeks, reduced to 50 units daily at start of mobilization and continued until fully mobile.

TERIPARATIDE:

Indications: treatment of osteoporosis in postmenopausal women and in men at increased risk of fractures.

Contraindications: pre-existing hypercalcemia, skeletal malignancies or bone metastases, metabolic bone diseases, including Paget’s disease and hyperparathyroidism, unexplained raised alkaline phosphatase, previous radiation therapy to the skeleton; pregnancy; breast-feeding.

Dose and Administration: By subcutaneous injection, 20 micrograms daily; max. duration of treatment 18 months.

Bisphosphonates and other drugs affecting bone metabolism

Bisphosphonates

Bisphosphonates are adsorbed onto hydroxyapatite crystals in bone, slowing both their rate of growth and dissolution, and therefore reducing the rate of bone turnover. Bisphosphonates have an important role in the prophylaxis and treatment of osteoporosis and corticosteroid-induced osteoporosis. Bisphosphonates are also used in the treatment of Paget’s disease, hypercalcemia of malignancy and in bone metastases in breast cancer.

ALENDRONIC ACID:

Indications: Treatment of postmenopausal osteoporosis and osteoporosis, Prevention of postmenopausal osteoporosis, Prevention and treatment of corticosteroid-induced osteoporosis.

Contraindications: abnormalities of esophagus and other factors, which delay emptying (e.g. stricture or achalasia), hypocalcemia, pregnancy and breast-feeding

Dose and Administration: 70 mg once weekly.

IBANDRONIC ACID:

Indications: Reduction of bone damage in bone metastases in breast cancer, Hypercalcaemia of malignancy, Treatment of postmenopausal osteoporosis.

Contraindications: pregnancy and breast-feeding.

Dose and Administration: 150 mg once a month.

SODIUM CLODRONATE:

Indications: Osteolytic lesions, hypercalcemia and bone pain associated with skeletal metastases in patients with breast cancer or multiple myeloma.

Contraindications: acute gastro-intestinal inflammatory conditions; pregnancy and breast-feeding.

Dose and Administration: 1.6 g daily in single or 2 divided doses increased if necessary to a max. of 3.2 g daily.

ZOLEDRONIC ACID:

Indications: Treatment of Paget’s disease of bone, Treatment of postmenopausal osteoporosis.

Contraindications: pregnancy and breast-feeding.

Dose and Administration: Treatment of Paget’s disease of bone, by intravenous infusion, 5 mg as a single dose over at least 15 minutes. Treatment of postmenopausal osteoporosis, by intravenous infusion, 5 mg over at least 15 minutes once a year.

ZOLEDRONIC ACID:

Indications: Reduction of bone damage in advanced malignancies involving bone, Hypercalcaemia of malignancy, child not recommended.

Contraindications: pregnancy and breast-feeding.

Dose and Administration: Reduction of bone damage in advanced malignancies involving bone, by intravenous infusion, 4 mg every 3–4 weeks. Hypercalcaemia of malignancy, by intravenous infusion, 4 mg as a single dose child not recommended

Strontium ranelate

STRONTIUM RANELATE:

Indications: treatment of postmenopausal osteoporosis to reduce risk of vertebral and hip fractures.

Contraindications: pregnancy, breast-feeding.

Dose and Administration: 2 g once daily in water, preferably at bedtime