Pharmacologic Profile

General Use

Bone resorption inhibitors are primarily used to treat and prevent osteoporosis in postmenopausal women. Other uses include treatment of osteoporosis due to other causes, including corticosteroid therapy, treatment of Paget's disease of the bone, and management of hypercalcemia.

General Action and Information

Bisphosphonates (alendronate, etidronate, ibandronate, pamidronate, risedronate, and zoledronic acid) inhibit resorption of bone by inhibiting hydroxyapatite crystal dissolution and osteoclast activity. Raloxifene binds to estrogen receptors, producing estrogen-like effects on bone including ↓ bone resorption and ↓ bone turnover.

Contraindications

Hypersensitivity. Bisphosphonates should not be used in patients with hypocalcemia. Raloxifene should not be used in women of reproductive potential or a history of thromboembolic disease.

Precautions

Use cautiously in patients with renal impairment; some agents should be avoided in moderate to severe renal impairment.

Interactions

Calcium supplements ↓ absorption of bisphosphonates. Aspirin may ↑ GI adverse reactions with bisphosphonates. Cholestyramine ↓ absorption of raloxifene (concurrent use is contraindicated).

Nursing Implications

Assessment

• Assess patients for low bone density before and periodically during therapy.
• Assess for symptoms of Paget's disease (bone pain, headache, decreased visual and auditory acuity, ↑ skull size).
• Monitor serum calcium in patients with osteoporosis. Monitor alkaline phosphatase in patients with Paget's disease.

Potential Nursing Diagnoses

• Risk for injury (Indications)
• Deficient knowledge related to disease processes and medication regimen (Patient/Family Teaching)

Implementation

Patient/Family Teaching

• Instruct patient to take medication exactly as directed.
• Encourage patient to participate in regular exercise and to modify behaviors that ↑ the risk of osteoporosis.

Evaluation/Desired Outcomes

• Prevention of, or decrease in, the progression of osteoporosis in postmenopausal women. Decrease in the progression of Paget's disease.