In one article, the precautions for commonly used anti-osteoporosis drugs!

*It is only for medical professionals to read.
Medications are not trivial.
Osteoporosis is a metabolic disease.
It is a systemic bone disease characterized by low bone mass and bone microstructure destruction, resulting in increased bone fragility and prone to fractures
.

 The drugs that we often use clinically to treat primary osteoporosis are divided into bone nutrition supplement drugs, bone resorption inhibitors, bone formation promoters and other mechanism drugs (see Table 1)
.

 Different types of anti-osteoporosis drugs have different methods of use
.

Therefore, the correct understanding of the precautions of various drugs can ensure the best curative effect and minimal adverse reactions
.

Today, let us take a look at several commonly used anti-osteoporosis drugs in clinical practice, and what problems should be paid attention to when using the drugs! Table 1 Primary osteoporosis drug treatment bone nutrition supplement drug bone resorption inhibitor bone formation promoting drug other mechanism drugs alfacalcidol (recommended) calcium phosphate (or calcium carbonate + vitamin D3) calcitriol alen Sodium phosphate (recommended) zoledron phosphate, riser, sodium phosphate, raloxifene, salmon calcitonin, calcitonin, teriparatide, ranelate, strontium epestrol, and brass bone nutritional supplement for osteotriol and calcium reduction Osteoporosis
.

 ▶The representative drug Alfacalcidol, 0.
5μg/d for adults, orally
.

Not suitable for pregnant women
.

Note when taking the medicine: 1.
Combined use with calcium agents may cause elevated blood calcium; combined use with high-dose phosphorus agents can induce hyperphosphatemia; combined use with thiazide diuretics may cause hypercalcemia; If hypercalcemia occurs in combination with rehmantoxin drugs, it is easy to induce arrhythmia; combined with barbiturates can accelerate the metabolism of active vitamin D metabolites in the liver and reduce the efficacy of this product; and cholestyramine or aluminum Combination of antacids can reduce the absorption of this medicine
.

 2.
Low-dose alone (<1.
0ug/d) generally has no adverse reactions.
Long-term high-dose medication or combined use with calcium may cause hypercalcemia and hypercalciuria.
It is recommended to check the blood calcium and urine calcium levels of patients regularly
.

 3.
Contraindications: It is contraindicated in those who are allergic to vitamin D and its analogues, hypercalcemia, and have signs of vitamin D poisoning
.

 ▶The commonly used medicine calcitriol is generally 0.
25μg orally once a day, 2 times a day or 0.
5μg orally once a day
.

You can take it with or without food, and take the medicine at the same time every day
.

Side effects such as hypercalcemia syndrome, constipation, and vomiting may occur after medication
.

Attention should be paid when taking the medicine: 1.
Drink a proper amount of water during the medicine
.

Patients with normal renal function must avoid dehydration during medication, so they need to ensure proper drinking
.

2.
Adequate intake of calcium
.

Avoid excessive calcium supplementation to cause hypercalcemia, and strictly control your diet according to the doctor's advice
.

3.
Blood calcium and blood phosphorus need to be checked regularly during medication
.

4.
Pay attention to drug interactions
.

Bile acid chelating drugs (such as cholestyramine) can reduce the absorption of calcitriol and affect its efficacy
.

If you need to use them together, the two should be separated by at least 4 hours
.

5.
Use with caution in patients with kidney stones
.

 ▶Calcium carbonate is a commonly used medicine, and the dosage of different dosage forms is different, and side effects such as abdominal distension, constipation, nausea, and vomiting may occur after administration
.

Note when taking the medicine: 1.
Take the medicine while eating or after a meal
.

If you are taking an effervescent preparation, you cannot swallow it directly.
Use about 100ml of warm or cold water to dissolve the drug before taking it
.

In order to avoid the rapid release of large amounts of gas to stimulate the mucous membrane, causing accidents
.

2.
Avoid taking it with milk
.

Taking milk with milk may cause milk-alkali syndrome, which can manifest as hypercalcemia, alkalosis and renal insufficiency
.

3.
Pay attention to drug interactions
.

The combination of calcium carbonate and other drugs may affect the absorption and efficacy of the drug.
Drugs that require an interval of at least 1 hour include pyrrole antifungal drugs (such as itraconazole) and cephalosporins (such as cefpodoxime); the interval is at least 2 The hourly drugs include quinolone drugs (such as levofloxacin) and pristine drugs (such as captopril); the drugs that require an interval of at least 4 hours include thyroid hormones (such as levothyroxine)
.

 Bone resorption inhibitors can inhibit the activity of osteoclasts and reduce bone resorption
.

 ▶Representative drug alendronate, which is taken once a week in usage.
Abdominal pain, constipation, diarrhea, bloating, indigestion, acid reflux, nausea, dysphagia, musculoskeletal pain, muscle cramps, headache, esophageal irritation may occur after administration.
, Esophageal ulcer, esophageal erosion, esophageal side effects
.

Note when taking the medicine: 1.
Take the medicine on an empty stomach in the morning
.

Take the medicine with white water (200-300ml).
Do not eat, drink, or take other medicines for at least half an hour after the medicine, otherwise it may reduce the absorption of the medicine
.

2.
Avoid lying down within 30 minutes after medication
.

Alendronate has irritation to the esophagus, and lying down while taking the drug will increase this irritation
.

3.
Swallow the medicine completely
.

Ordinary tablets and enteric-coated tablets should be swallowed whole, not chewed or sucked, so as not to cause oropharyngeal ulcers
.

4.
Take the medicine at the same time
.

Take it in the morning on a fixed day of the week
.

If you miss a dose, you can take the medicine in the morning on the second day after you remember it, and then take the medicine according to the normal plan, not twice a day
.

5.
People who are allergic to this product, those whose creatinine clearance rate is less than 35ml/min, pregnant women and breast-feeding women are contraindicated
.

 ▶The commonly used drug salmon calcitonin
.

The usage is generally 50-100U subcutaneously or intramuscularly, once a day
.

Side effects such as facial flushing and nausea may occur after medication
.

Note when using: 1.
Try to avoid dangerous behaviors such as driving
.

Fatigue, dizziness, and impaired vision may occur after medication
.

2.
Store at 2-8°C
.

After taking the medicine out of the refrigerator, let it stand for about 20 minutes until the temperature returns to room temperature
.

3.
Skin allergy test should be done before using this medicine injection
.

4.
Prohibited for pregnant women
.

 ▶The commonly used drug zoledronic acid
.

In terms of usage, adults usually 5mg/time, once/year, intravenous infusion should not be less than 15min; it is not recommended for children and adolescent patients under 18 years of age; elderly patients do not need to adjust the dosage
.

 Note when using: 1.
Combining with drugs that significantly affect renal function such as aminoglycosides or diuretics may induce hypocalcemia
.

2.
Fever may appear after medication, or flu-like symptoms such as chills, fatigue, weakness and pain, skeletal muscle pain such as myalgia, arthralgia, bone pain, and back pain may appear, but generally mild and transient
.

3.
It is contraindicated in people who are allergic to zoledronic acid or other bisphosphonates, patients with severe renal insufficiency, and women during pregnancy and lactation
.

 ▶The commonly used drug Raloxifene
.

Usage is usually 60 mg orally once, once a day
.

It can be taken with or without food, and can be taken at any time of the day
.

Side effects such as hot flashes, leg cramps, flu symptoms, and edema may occur after medication
.

Note when taking the medicine: 1.
Take it for a long time
.

Calcium and vitamin D should be supplemented at the same time during medication.
It is recommended that postmenopausal women consume 1500 mg of calcium per day and 400-800 units of vitamin D per day
.

2.
Avoid sitting or lying for a long time after medication
.

Sitting or lying for a long time during the medication will increase the risk of blood clots
.

If you need to lie down for a long time, you need to stop the medication for at least 72 hours before you can move around freely
.

It is best to get up and walk around regularly when traveling long distances
.

 Bone formation promoting drugs have the effect of promoting bone formation and are used for osteoporosis caused by weakened osteoblast activity
.

 ▶The commonly used drug Teriparatide is generally 20μg once, subcutaneously injected once a day
.

The total course of treatment should not exceed 24 months
.

After medication, side effects such as palpitations, anemia, dizziness, dizziness, headache, limb pain, nausea, and vomiting may occur
.

Attention should be paid when using: 1.
Treatment after drug withdrawal
.

After stopping the drug, other osteoporosis treatments can be continued
.

2.
Try to avoid dangerous behaviors such as driving
.

Fatigue, dizziness, and impaired vision may occur after medication
.

3.
Avoid overdose
.

If the drug is overdose, the medication should be suspended, blood calcium and phosphorus should be monitored, and appropriate supportive treatment (such as hydration therapy) should be given
.

4.
Prohibited for pregnant women
.

 Other mechanisms can promote bone formation and improve bone strength.
It is also used for osteoporosis caused by the ten functions of osteoclasts and osteoblasts
.

 ▶The commonly used drug, strontium ranelate, is generally taken orally 2g once a day, once a day
.

Side effects such as nausea, diarrhea, headache, dermatitis, and eczema may occur after medication
.

 Note when taking the medicine: 1.
Take the medicine on an empty stomach before going to bed
.

Because food and dairy products can reduce the absorption of strontium ranelate, the drug itself is absorbed slowly, so it is best to take the drug on an empty stomach before going to bed (2 hours after dinner)
.

2.
Pay attention to drug interactions
.

Antacids and calcium agents can reduce the efficacy of strontium ranelate.
When used in combination, take strontium ranelate 2 hours after taking it
.

Add at least 30ml of water to the dry suspension of this medicine and take it immediately after stirring
.

3.
Long-term medication
.

Please adhere to prescribed medication, pay attention to supplement calcium and vitamin D
.

 References: [1] Osteoporosis and Bone Mineral Diseases Branch of Chinese Medical Association.
Guidelines for the diagnosis and treatment of primary osteoporosis (2017) [J].
Chinese Journal of Osteoporosis and Bone Mineral Diseases, 2017, 10(5): 413-444.
[2] Chinese Medical Association, Chinese Medical Association Journal, Chinese Medical Association General Practitioners Branch, etc.
Primary Osteoporosis Primary Diagnosis and Treatment Guidelines-Practice Edition [J].
Chinese Journal of General Practitioners, 2020, 19(4): 316-323.
[3] Chinese Medical Association, Chinese Medical Association Clinical Pharmacy Branch, Chinese Medical Association Journal, etc.
Guidelines for rational use of osteoporosis at the grassroots level [J].
Chinese Journal of General Practitioners, 2021, 20(5): 523-529 .