Alendronate
Alendronate is more effective in the prevention of glucocorticoidinduced bone loss than alfacalcidol, according to the results of this randomised, double-placebo, doubleblind clinical trial. 201 patients with a rheumatic disease who were starting glucocorticoids at a daily dose equivalent to at least 7.5mg of prednisone were randomised to receive either alendronate 10mg daily ; plus a placebo capsule or alfacalcidol 1 microgram daily ; plus a placebo tablet. The primary outcome was the change in bone mineral density BMD ; of the lumbar spine at 18 months. The secondary outcome was the incidence of morphometric vertebral deformities. Of the 163 patients who completed the study, 2.1% in the alendronate group [95% CI 1.1 to 3.1%] had an increased BMD of the lumbar spine compared with a decrease of 1.9% in the alfacalcidol group [3.1 to 0.7%]. At 18 months, the mean difference of change in BMD between the two groups was 4.0%; [2.4% to 5.5%]. Three patients in the alendronate group had a new vertebral deformity compared with eight patients in the alfacalcidol group of whom three had symptomatic vertebral fractures.
Our results show that there is limited evidence available to support the use of bisphosphonates for the primary prevention of fractures in women with osteoporosis. The only benefit observed was a 45% reduction in vertebral fractures associated with alendronate. As a result, an economic evaluation of the use of bisphosphonates in this clinical context is unwarranted. Available evidence indicates that the main benefits of bisphosphonate therapy lie in the secondary prevention of osteoporotic fractures. The evidence also indicates that the magnitude of this effect varies among bisphosphonates. The effect of etidronate is limited to a 47% reduction in vertebral fractures; whereas risedronate prevents the recurrence of vertebral, non-vertebral, and hip fractures. Risedronate provides a 39% reduction in vertebral fractures, a 20% reduction in non-vertebral fractures, and a 26% reduction in hip fractures. In comparison, alendronate prevents the recurrence of all osteoporotic fractures, with reductions in vertebral 45% ; , non-vertebral 23% ; , hip 53% ; , and wrist 48% ; fractures. For wrist fracture, the supporting evidence for alendronate is not as strong as it is for the other sites. The differences in effect may partly explain the uptake by prescribers. In 2004, the Canadian market share of these drugs, based on utilization data provided by IMS Health Table 2 ; , were alendronate.
Background Despite its association with disability, death, and increased medical costs, osteoporosis in men has been relatively neglected as a subject of study. There have been no large, controlled trials of treatment in men. Methods In a two-year double-blind trial, we studied the effect of 10 mg of alendronate or placebo, given daily, on bone mineral density in 241 men age, 31 to 87 years; mean, 63 ; with osteoporosis. Approximately one third had low serum free testosterone concentrations at baseline; the rest had normal concentrations. Men with other secondary causes of osteoporosis were excluded. All the men received calcium and vitamin D supplements. The main outcome measures were the percent changes in lumbar-spine, hip, and total-body bone mineral density. Results The men who received alendronate had a mean SE ; increase in bone mineral density of 7.1 0.3 percent at the lumbar spine, 2.5 0.4 percent at the femoral neck, and 2.0 0.2 percent for the total body P 0.001 for all comparisons with baseline ; . In contrast, men who.
Tricular systolic function during or after the subsequent pregnancy. One patient had 2 subsequent pregnancies after the index pregnancy, with worsening heart failure occurring after the second subsequent pregnancy but not after the first subsequent pregnancy. We could not identify any characteristic that distinguished the group with subsequent pregnancy n 15 ; from the group without subsequent pregnancy n 84 ; Table 1 ; . Also, except for recovery of left ventricular systolic function, we could not find a distinguishing feature between the group that fully recovered n 8 ; and the group that continued to have abnormal heart function n 7 ; . The Figure shows the mean echocardiographic left ventricular ejection fractions over time. Table 2 shows the treatment regimens for the 15 patients with PPCM and subsequent pregnancy. Approximately 75% of the 99 patients with PPCM accepted family-planning measures and did not become pregnant again. Among the 25 patients who did not use family-planning measures, 14 became pregnant again. One patient became pregnant again despite having an intrauterine device, for instance, alendronate 10.
Osteopenia, we recommend supplementation with calcium 1500 mg day ; and vitamin D 400 IU day ; . We also suggest that menopausal women commence HRT. Wo m e who have a history of Hodgkin's disease or mantle radiation or who have an increased risk for breast cancer are o ff e red raloxifene instead. Men with decreased testosterone are given testosterone replacement therapy either intramuscularly or transdermally. For patients with a T score less than 2.5, we offer the latter therapy in addition to alendronate 10 mg day ; . Patients with myeloma may substitute monthly intravenous pamidronate or daily oral clodronate for alendronate. Both pamidronate and clodronate d e c rease skeletal events in patients with myeloma. The choice between pamidronate and clodronate is mainly determined by availability and cost as well as by patient and physician preferences. In conclusion, osteopenia and osteoporosis are common complications of BMT. Many patients have significant bone loss before transplantation and experience further decreases in bone density after transplantation. Since early recognition and aggressive treatment of bone loss can prevent bone fracture, we suggest that bone densitometry and aggressive preventive therapy should be integral components to followup of long-term BMT survivors.
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Results of the log-rank test which reflects only crude differences in the survival curves ; indicate that both alendronate and risedronate were significantly different from nasal calcitonin at P 0.05!
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That of taking alendronate once a week. The claim `Bonviva once-monthly for postmenopausal osteoporosis' appeared as the heading to a page which featured a pie chart depicting patient preference for the two therapies. The Panel considered that many readers would assume that it was a simple choice between once-weekly and oncemonthly therapy and that in all other respects the two medicines were equal. Prescribers might be persuaded to change patients from alendronate to Bonviva in the belief that the proven benefits of therapy were the same for each medicine. This was not so. Alendromate could be used to reduce the risk of vertebral and hip fracture whereas the efficacy of Bonviva on hip fractures had not been established. The Panel noted that there were three third generation bisphosphonates licensed for the treatment of PMO Actonel, Fosamax and Bonviva ; all of which could be used to decrease the risk of vertebral fracture. The Panel thus considered that a decrease in the risk of vertebral fracture would be seen by prescribers to be an accepted benefit of therapy with these agents. The medicines differed, however, in their licensed effects on hip fracture; Fosamax decreased the risk of hip fracture; Actonel decreased the risk of hip fracture but only in established PMO and the efficacy of Bonviva on hip fractures had not been established. Given the differences between the products, and the clinical consequences of hip fracture, the Panel considered that it was beholden upon companies to be abundantly clear about the terms of their product's marketing authorization. The claim `Bonviva once-monthly for postmenopausal osteoporosis' headed a page which compared Bonviva with alendronate. The Panel noted its comments above and considered that by association readers would assume that Bonviva decreased the risk of both vertebral and hip fractures which was not so. The Panel considered that the failure to note that efficacy on hip fractures had not been established meant that the claim at issue, within the context of which it appeared, was misleading and incapable of substantiation. Breaches of the Code were ruled. The Panel considered that the claim, in the context in which it appeared, implied that Bonviva reduced the risk of hip fracture which was inconsistent with the particulars listed in the marketing authorization. The Panel ruled a breach of the Code. Upon appeal by Roche and GlaxoSmithKline. the Appeal Board noted that Bonviva was indicated for the `Treatment of osteoporosis in postmenopausal women in order to reduce the risk of vertebral fractures. Efficacy on femoral neck fractures has not been established'.
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Assessing and Treating Sexually Aggressive Youth. Workshop Presenter: James Worling, Ph.D. Sponsored by the IWK Health Centre and the Nova Scotia Initiative for Sexually Aggressive Youth Psychology on Trial: The Mental Health Professional as an Expert Witness A conference sponsored by the Clinical Psychology Ph.D. Program of Dalhousie University and R. A. Murtha & Associates, Barristers & Solicitors. Treating Anxiety Disorders in Youth Workshop presenter: Dr. Philip Kendall of Temple University. Sponsored by Dr. G. Wayne Professional Psychology Lecture Series of the IWK Health Centre. Structured Clinical Interview for DSM-IV SCID ; Training Workshop Workshop Presenter: Leslie Ann Campbell, B N, M . CH&E ; , Department of Psychiatry, Dalhousie University. Sponsored by the Clinical Psychology Ph.D. Program of Dalhousie University. Children in Limbo two-day workshop on the assessment and treatment of Attachment Disorders ; Workshop presenter: Dr. Paul Steinhauer, Professor of Psychiatry, University of Toronto's Division of Child Psychiatry and the Hospital for Sick Children. Suicide Intervention Workshop - 14 credit hours of category 1 study credit of the College of Family Physicians of Canada. These agents are representative of a wide variety of therapeutic classes, and each works differently in the treatment prevention of osteoporosis. Alendrpnate and risedronate represent a class of medications known as bisphosphonates. The wide variety of indications for bisphosphonates include osteoporosis in postmenopausal women, osteoporosis in men, corticosteroid-induced osteoporosis, Paget's disease, heterotopic ossification, hypercalcemia of malignancy, breast cancer multiple myeloma in conjunction with standard antineoplastic therapy for treatment of osteolytic bone metastases, multiple myeloma, and bone metastases of solid tumors. Because of the topic of this review, only the indications for alendeonate and risedronate will be discussed. Teriparatide and calcitonin belong to the parathyroid class of agents. Calcitoninsalmon is indicated for postmenopausal osteoporosis, Paget's disease of bone injection only ; , and hypercalcemia injection only ; . The nasal spray formulation of this agent should be used only in patients who cannot take estrogen. Teriparatide is indicated for use in postmenopausal women and in men with idiopathic or hypogonadal osteoporosis who are at high risk for fractures. Finally, raloxifene is indicated for the treatment and prevention of osteoporosis in postmenopausal women. The mechanism of action differs from class to class. Bisphosphonates in general work by inhibiting normal and abnormal bone resorption, with alendronat4 showing preferential localization to sites of bone resorption, specifically under osteoclasts.1 This agent does not inhibit osteoclast attachment or recruitment but inhibits osteoclast activity. Risedronate acts in a similar way to inhibit osteoclast activity.2 Calcitonin plays a role in the regulation of calcium and bone metabolism and has direct renal effects as well as actions on the gastrointestinal tract. Prolonged use of and anastrozole. In a study comparing alendronate, vitamin D and calcitriol, alendrinate increased lumbar spine BMD by 5.9% over 2 years, compared to 0.5% and 0.7% loss on vitamin D and calcitriol respectively. There was no difference at the femoral neck115. Alendronare and risedronate reduces vertebral fractures in patients on glucocorticoid therapy100.113. In patients on glucocorticoids with osteoporotic fractures or confirmed osteoporosis on DXA, bisphosphonates are the first-line treatment. Grade A, Level Ib ; Treatment should be continued as long as the patients are on glucocorticoids14. Upon discontinuation of glucocorticoids, treatment should be continued as in nonglucocorticoid osteoporosis for those with established or high risk of osteoporosis. Grade C, Level IV.
Alendronate vs fosamax
Conclusion in a patient population 65 years of age or older initiating bisphosphonate therapy for osteoporosis, risedronate was associated with markedly lower gi-related diagnoses, medical resource utilization, and direct medical costs compared with alendronate. Agent Calcium elemental calcium ; Vitamin D Etidronate Didrocal ; Alendrnoate Fosamax ; Risedronate Actonel ; Raloxifene Evista ; Calcitonin Miacalcin ; Parathyroid Hormone Teriparatide ; Dose 1500 mg daily total of dietary and supplements ; 800 IU daily 400 mg daily for 2 weeks every 3 months, given cyclically with calcium 70 mg weekly 35 mg weekly 60 mg daily $200 IU daily, intranasal 20 mcg sc daily Cost per month $5.00 $17.30 ODB status No not prescription ; No not prescription ; Covered and atarax. 3.3 Risk factors for Osteoporosis: Osteoporosis is a silent disease without any symptoms in most patients until fractures have occurred. While population screening is not cost effective, identification of risk factors will help in case finding8. Grade C, Level IV ; The major factors associated with an increased risk of osteoporotic fracture in postmenopausal women are shown in Table 4.9 Table 4: Risk Factors9 Non- modifiable 1. Advancing age 2. Ethnic group Oriental & Caucasian ; 3. Female gender 4. Premature menopause 45 years ; including surgical menopause 5. Slender build 6. Family history of osteoporosis in first degree relative 7. Personal history of fracture as an adult Modifiable 1. Low calcium intake 2. Sedentary lifestyle 3. Cigarette smoking 4. Excessive alcohol intake 5. Excessive caffeine intake 6. Low body weight 127lb. ; 7. Estrogen deficiency 8. Impaired vision 9. Recurrent falls.
Alendronate for womenPharmacokinetics Absorption Relative to an intravenous IV ; reference dose, the mean oral bioavailability of alendronate in women was 0.64% for doses ranging from 5 to 70 mg when administered after an overnight fast and two hours before a standardized breakfast. Oral bioavailability of the 10 mg tablet in men 0.59% ; was similar to that in women when administered after an overnight fast and 2 hours before breakfast. FOSAMAX 70 mg oral solution and FOSAMAX 70 mg tablet are equally bioavailable. A study examining the effect of timing of a meal on the bioavailability of alendronate was performed in 49 postmenopausal women. Bioavailability was decreased by approximately 40% ; when 10 mg alendronate was administered either 0.5 or 1 hour before a standardized breakfast, when compared to dosing 2 hours before eating. In studies of treatment and prevention of osteoporosis, alendronate was effective when administered at least 30 minutes before breakfast. Bioavailability was negligible whether alendronate was administered with or up to two hours after a standardized breakfast. Concomitant administration of alendronate with coffee or orange juice reduced bioavailability by approximately 60%. Distribution Preclinical studies in male rats ; show that alendronate transiently distributes to soft tissues following 1 mg kg IV administration but is then rapidly redistributed to bone or excreted in the urine. The mean steady-state volume of distribution, exclusive of bone, is at least 28 L in humans. Concentrations of drug in plasma following therapeutic oral doses are too low less than 5 ng mL ; for analytical detection. Protein binding in human plasma is approximately 78%. Metabolism There is no evidence that alendronate is metabolized in animals or humans and atorvastatin. Benefits — rates of postpartum fever, wound infection, blood transfusion, hysterectomy, maternal discomfort, and length of hospital stay are all lower with vbac than with repeat cesarean delivery.Usual doses of capsules or tablets that are inadvertently retained in the oesophagus may result in oesophagitis. Patients with pre-existing oesophageal compression or oesophageal reflux may be at a higher risk for drug-induced oesophagitis as are those who take pills with little or no fluid or taking the pill just prior to bedtime. Commonly prescribed drugs that cause oesophageal injury include doxycycline, tetracycline, clindamycin, aspirin, potassium chloride, ferrous sulphate, various steroidal and nonsteroidal antiinflammatory agents and alendronate. Most common presenting symptoms of pill-induced oesophagitis include odynophagia painful swallowing of food ; , dysphagia, or continuous retrosternal pain. Most uncomplicated cases of drug-induced oesophagitis heal spontaneouly with resolution of symptoms in a few weeks. Prevention remains the best option to combat the occurrence of drug-induced oesophagitis. Advise patients to take their medicine with a full glass of water and to maintain an upright position for at least 15-30 min after drug administration and axid and alendronate. | Bisphosphonate alendronateSTATESBORO IMAGING CENTER BONE DENSITY QUESTIONNAIRE Name Sex Height Weight Race: African American Asian Caucasian Hispanic Native American Other Are you: Right Handed Left Handed Have you fractured any bones in your lower back, hip, or wrist? Have you had any surgery to your lower back, hip, or wrist? Does your family have a history of osteoporosis? Do you smoke more than half a pack of cigarettes per day? Have you smoked in the past? Do you take a calcium supplement daily? If so, how much? mg day Do you exercise at least 3 times per week? Do you drink more than 2 alcoholic beverages per day? Do you drink more than 2 cups of tea or coffee per day? Have you taken any of the following medications treatments? Steroids Prednisone, Cortisone, etc. ; Thyroid medication Anticonvulsants for Seizures, epilepsy ; Loop Diuretics Lasix, Bumex, Edicrin ; Heparin blood thinners ; Chemotherapy Lithium Multivitamins or Vitamin D Evista raloxifene ; Miacalcin calcitonin ; Fosamax alendronate ; Actonel risidronate ; Forteo Tamoxifen Testosterone Other osteoporosis medications Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No STATESBORO IMAGING CENTER Have you had any of the following conditions? Hyperthyroidism or Hyperparathyroidism Cirrhosis of the liver Kidney disease Rheumatoid arthritis Other arthritis Part of stomach removed Intestinal or bowel disease Eating disorders anorexia, bulimia, etc. ; Have you had a barium X-ray in the last 2 weeks? Have you had a nuclear medicine scan or injection of an X-ray dye in the last week? Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No Remaining questions for WOMEN ONLY Is there a chance that you are pregnant? Have you gone through menopause? If so, what age? Have you ever taken hormones not including birth control pills ; ? Have you had any of the following conditions? Hysterectomy Ovaries removed Breast cancer Cancer of the uterus womb ; Yes Yes Yes Yes Yes Yes Yes No No No Drug Formulary Update Dear Member, Effective January 1, 2007 your Preferred Drug List will be updated to include the following preferred brand drug additions and deletions. The list below details those drugs that will now be available at the preferred copay, as well as those drugs that will be moving from preferred status to non-preferred status. New Preferred Drugs: TAMIFLU TRAVATAN Z Drugs moving to Non-Preferred with Preferred Brand Alternatives PREFERRED BRANDS ; LESCOL XL CRESTOR, NIASPAN, VYTORIN ; Drugs moving to Non-Preferred with Generic Available generic equivalent ; COLESTID colestipol ; DIPROLENE AF betamethasone dipropionate augmented ; EFFEXOR venlafaxine ; FLONASE fluticasone propionate ; GRIFULVIN V griseofulvin ; NIZORAL ketoconazole ; PARNATE tranylcypromine sulfate ; PERIOSTAT doxycycline hyclate ; PERMAX pergolide ; PLEXION sulfacetamide sodium sulfur ; REBETOL ribavirin ; SPORANOX itraconazole ; ZADITOR ketotifen ; ZAROXOLYN metolazone ; ZITHROMAX azithromycin ; RxEDO's Pharmacy & Therapeutics P&T ; Committee continually evaluates all drugs available in the market. Updates are based on those drugs that produce the best medical outcomes for our members. Please review and discuss these changes with your physician. Should you have any questions please contact our member services department toll free at 888 ; 879-7336. Thanks! The RxEDO Member Services Team.Alendronate raloxifene |
HORMONAL AGENTS, STIMULANT REPLACEMENT MODIFYING ADRENAL ; MINERALOCORTICOIDS Generics fludrocortisone acetate FLORINEF * Generic HORMONAL AGENTS, STIMULANT REPLACEMENT MODIFYING PARATHYROID METABOLIC BONE DISEASE AGENTS ; Generics calcitonin salmon ; FORTICAL Generic 1bottle 3.7mL ; per 30 days calcitriol ROCALTROL * Generic pamidronate disodium AREDIA * Generic Brands alendronate sodium 10 mg tab FOSAMAX Preferred Brand 30 per 30 days alendronate sodium 35 mg tab FOSAMAX Preferred Brand 4 per 28 days alendronate sodium 40 mg tab FOSAMAX Preferred Brand 30 per 30 days alendronate sodium 5 mg tab FOSAMAX Preferred Brand 30 per 30 days alendronate sodium 70 mg tab FOSAMAX Preferred Brand 4 per 28 days alendronate sodium liquid FOSAMAX LIQUID Preferred Brand 300 mL per 30 days alendronate sodium-cholecalciferol FOSAMAX PLUS D Preferred Brand 4 per 28 days doxercalciferol HECTOROL Preferred Brand STEP paricalcitol ZEMPLAR Brand STEP risedronate sodium 30 mg tab ACTONEL Preferred Brand 30 per 30 days risedronate sodium 35 mg tab ACTONEL Preferred Brand 4 per 28 days risedronate sodium 5 mg tab ACTONEL Preferred Brand 30 per 30 days risedronate sodium, calcium carbonate ACTONEL WITH CALCIUM Preferred Brand 4 per 28 days teriparatide recombinant ; FORTEO Brand 1 pen per 28 days, PA zoledronic acid ZOMETA Brand HORMONAL AGENTS, STIMULANT REPLACEMENT MODIFYING PITUITARY ; Generics desmopressin acetate nasal soln DDAVP * Generic. Multiparticulate formulations, because of their nature of dispersing in the gastrointestinal tract, show a reduced food effect and variability in gastric emptying times, thereby providing for reduced inter and intra subject variability, as compared to single unit tablets intl, for example, alendronate cholecalciferol.
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