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Who Should Avoid Bisphosphonates? Understanding the Contraindications
Published: Dec 11, 2023
While bisphosphonates are effective for many with osteoporosis, they're not suitable for everyone. Certain health conditions and factors can make these medications risky or ineffective.
Kidney Function Concerns
People with severe kidney problems should generally avoid bisphosphonates. These medications aren't recommended for those with a creatinine clearance below 30-35 mL/min. This is because the kidneys play a crucial role in eliminating bisphosphonates from the body. Poor kidney function can lead to drug buildup and potential complications.
Digestive System Issues
Oral bisphosphonates are contraindicated in people with certain esophageal disorders. This includes conditions like achalasia, strictures, or severe gastroesophageal reflux disease (GERD). The medication can irritate the esophagus, potentially causing or worsening existing problems. For these individuals, intravenous bisphosphonates might be a safer option.
Absorption Problems
People who've had certain types of weight loss surgery, particularly those involving intestinal bypass, may not be good candidates for oral bisphosphonates. These surgeries can affect how the body absorbs the medication, making it less effective. Similarly, any condition that significantly impairs nutrient absorption could interfere with bisphosphonate effectiveness.
Other Contraindications
Bisphosphonates shouldn't be used in people with low blood calcium levels (hypocalcemia) until this is corrected. They're also not recommended during pregnancy or for people with a known allergy to bisphosphonates. Those unable to remain upright for at least 30 minutes after taking the medication should avoid oral forms.
Frequently Asked Questions
No, several factors determine if they're appropriate.
No, they're not recommended during pregnancy.
Possibly, but it requires careful monitoring by a doctor.
Yes, other osteoporosis treatments are available.
Mostly, but there can be some differences between oral and IV forms.
The Bottom Line
While bisphosphonates help many, they're not right for everyone - always consult your doctor.
References
- FDA. Bisphosphonates: Drug Safety Communication.
- Miller PD, et al. J Bone Miner Res. 2005;20:2105-2115.
This article has been reviewed for accuracy by one of the licensed medical doctors working for Doctronic. Always discuss health information with your healthcare provider.
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