意外にわかっているようで、分かっていない、分かりにくいBisphosphonateについてです。Reviewが出ています。
Bisphosphanates: Mechanism of Action and Role in clinical practice [Mayo Clin Proc 2008;83:1032-1045]
http://www.mayoclinicproceedings.com/content/83/9/1032
なかなか勉強になります。Bisphosphonateでの治療前にはVitDやCaの充分なintakeが必要。optimal serum levels of 25-hydroxyvitamin D: 30ng/mlである. Bisphosphonateの注意点が目に留まった、、。
●Osteonecrosis of the jaw
Whereas the incidence of ONJ is estimated to be 1 to 10 per 100 oncology patients, the risk of ONJ appears to be substantially lower among patients receiving oral bisphosphonate thrapy for osteoporosis, with an estiamted incidence of approximately 1 in 100,000 to 1 in 100,000 patient treatment years, although this estimate si based on incomplete data.
リスクはpoor oral hygiene, dental proceduresや義歯のヒストリーのある人、
high IV bisphosphonateの投与など。リスクは低いが、一度なると大変です。bisphosphonateの血中濃度はそれそのものではなくて活性産物を測定しているのでまだ分かっていない部分もあるようです。とにかく半減期が長い。
●Atrial fibrillation
The etiology of this electrophysiologic abnormality is unknwon.
●Oversuppression of bone turnover
→高容量ではfrozen boneとなりfractureとなるる場合がある。通常の量では問題ないが、、、、、
●Hypocalcemia
●Acute inflammatory response
Approximately 10% to 30% of patients receiving their first nitrogen-containing bisphosphonate infusion will experience an acute phase reaction, most commonly characterized by
transient pyrexia with associated myalgia, arthralgia, headaches, and influenza-like symtptoms.
A relatively rare advedrse effect of bisphosphonate therapy of which physicians should be aware is
ocular inflammation (conjunctivitis, uveitis, episcleritis, and scleritis).
●Severe musculoskeletal pain これはあまり考えたことなかった、、。
This
severe musculoskeletal pain was distinct from the acute phase response described previously.
●Other potential complications of Bisphosphonate therapy
Esophageal irritation and erosion can occur with oral bisphosphonate therapy, particularly in patients with known gastroesophageal reflux disease or esophageal stricture.
その他 Managing skeletal related events resulting from bone metastasis [BMJ 2008;337:1101-1105]もあります。
http://www.bmj.com/cgi/content/extract/337/nov03_1/a2041?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=
&fulltext=managing+skeletal+related+events&searchid=
1&FIRSTINDEX=0&resourcetype=HWCIT
Bone metastasisのpainに関してhalf body treatmentなどの6 or 8Gy をone fractionで照射する方法もあるようです。
