Review Question - QID 108539

This patient has osteoporosis and is started on a bisphosphonate. One major side effect of bisphosphonates is osteonecrosis of the jaw.

Osteoporosis is a condition characterized by low bone mineral density leading to an increased risk of fracture. Specifically, patients with osteoporosis are at higher risk for hip fractures, distal radius fractures, and vertebral compression fractures. Osteoporosis is diagnosed via DEXA scan with a T-score below -2.5, indicating low bone mineral density. Bisphosphonates (e.g., alendronate and risendronate) are a class of medications used to prevent and treat osteoporosis. They are also used to treat Paget’s bone disease, osteogenesis imperfecta, and certain cancers affecting the bone. Bisphosponates slow bone loss by inducing apoptosis in osteoclasts. In doing so, they interrupt the normal cycle of bone turnover by inhibiting bone breakdown. Major side effects of bisphosphonates are esophagitis and osteonecrosis of the jaw.

Incorrect Answers:
Answer 1: Patients with osteoporosis are at increased risk of sustaining vertebral compression fractures. The use of bisphosphonates is intended to reduce the risk of these fractures by slowing bone loss.

Answer 3: Agranulocytosis is an adverse effect of multiple medications including clozapine and carbamazepine. It is not an adverse effect of bisphosphonates.

Answer 4: Gingival hyperplasia is a side effect of phenytoin and cyclosporine. It is not an adverse effect of bisphosphonates.

Answer 5: Interstitial nephritis is an adverse effect of certain medications such as methicillin, NSAIDs, acetaminophen, and furosemide. It is not an adverse effect of bisphosphonates.

Bullet Summary:
Bisphosphonates are drugs that induce osteoclast apoptosis and are used to treat osteoporosis, osteogenesis imperfecta, and Paget’s bone disease. Side effects of bisphosphonates include esophagitis and osteonecrosis of the jaw.