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Bisphosphonates are used to treat osteoporosis, osteitis deformans (Paget's disease of the bone), bone metastasis (with or without hypercalcemia), multiple myeloma, and other conditions involving fragile, breakable bone. In osteoporosis and Paget's, the most popular first-line bisphosphonate drugs are alendronate and risedronate.
These include osteoporosis, high blood calcium due to cancer, bone breakdown due to cancer, Paget's disease of bone [3] and Duchenne muscular dystrophy (DMD). It is given by injection into a vein. [3] Common side effects include fever, joint pain, high blood pressure, diarrhea, and feeling tired. [3]
To prevent steroid-induced osteoporosis, the steroid dose and duration should be as low and as short as possible. All patients on long term glucocorticoids (≥3 months) should be encouraged to do weightbearing exercise, avoid smoking and excess alcohol and take fall prevention measures. Daily calcium and vitamin d intake should be sufficient.
Intra-articular corticosteroid injections (IACI) are a second-line therapy to relieve joint pain resulting from rheumatoid arthritis. [19] It is most commonly injected into the joints of the knees and shoulders. [19] Although the injection is local, studies have shown systemic absorption as evidenced by beneficial effects on distant joints. [19]
It is used to prevent bone loss, and treat osteoporosis. It is also used to strengthen bone in Paget's disease, to prevent bone loss due to steroid use, and in certain cancers with high propensity to bone, such as multiple myeloma. Due to its ability to sequester calcium in bone, it is also used to treat high calcium levels.
Cortisone is a pregnene (21-carbon) steroid hormone.It is a naturally-occurring corticosteroid metabolite that is also used as a pharmaceutical prodrug. Cortisol is converted by the action of the enzyme corticosteroid 11-beta-dehydrogenase isozyme 2 into the inactive metabolite cortisone, particularly in the kidneys.
Then change to oral hydrocortisone or cortisone as a single morning dose, and gradually decrease by 2.5 mg each week. When the morning dose is less than replacement, the return of normal basal adrenal function may be documented by checking 0800 cortisol levels prior to the morning dose; stop drugs when 0800 cortisol is 10 μg/dl.
Alendronic acid, sold under the brand name Fosamax among others, is a bisphosphonate medication used to treat osteoporosis and Paget's disease of bone. [4] It is taken by mouth. [4] Use is often recommended together with vitamin D, calcium supplementation, and lifestyle changes. [4]