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Biphosphonate therapy

Dear Sir or Madam,

What does a biphosphonate therapy as a treatment for osteoporosis involve? How is this therapy performed and what are the side effects? I read that biphosponates are also used in persons with cerebral tumours… it seems to me that it is a very strong drug. Is such a therapy to be recommended for CF individuals with osteoporosis?

Dear N.,

Biphosphonates are drugs that have been delevoped in the recent years, e.g. as a therapy for osteoporosis; they are used more and more for the treatment of CF-related osteoporosis. They inhibit bone resorption [decrease bone removal] but at the same time also inhibit bone mineralisation, since they are integrated in the bone substance themselves and stay there for a very long time. In this respect, they offer a double benefit in case of CF-related osteoporosis. First, because they inhibit most probably the increased bone resorption and secondly compensate the defective bone composition in that effect that they become part of the bone substance themselves.

However, before this therapy is started, other therapies should be tried to decrease bone removal and to improve bone regeneration in CF. Your CF doctor has guidelines at his disposal which tell him when it is really adequate to use these drugs.

Regarding the side effects there is a difference between biphosphonates that are administered orally or IV (intravenously). Orally administered preparations [drugs] have sometimes caused abdominal pain, nausea, vomiting, reflux of stomach contents into the oesophagus (gastro-oesophageal reflux) and diarrhoea. Furthermore, they can bind calcium in the intestine and thereby influence the calcium in the body. For some preparations osteonecrose has been described in few cases and for a newer preparation cardiac arrhythmia as well.

I think, before starting such a therapy, it is important to clarify all questions extensively with the attending physician.

Many greetings,
Olaf Sommerburg