Is it prudent to prescribe an oral bisphosphonate for an elderly woman with osteoporosis who has had acute hemorrhaging from a lower colonic diverticulum, for which a transfusion of 3 units of packed red blood cells was required?
Is it prudent to prescribe an oral bisphosphonate for an elderly woman with osteoporosis who has had acute hemorrhaging from a lower colonic diverticulum, for which a transfusion of 3 units of packed red blood cells was required? Would teriparatide be a more appropriate choice in this setting?
- Robert P. Blereau, MD
Morgan City, La
Oral bisphosphonates, such as risedronate and alendronate, have been associated with adverse events of the upper GI tract--predominantly esophagitis and gastritis. Acute bleeding from the lower GI tract, such as the hemorrhaging from a colonic diverticulum in this woman, would not be caused or aggravated by an oral bisphosphonate.
However, as long as your patient remains ill and requires hospitalization, it would be wise to withhold oral bisphosphonate therapy. This is because it would be difficult for her to adhere to the strict requirements of fasting and remaining upright for 30 to 60 minutes that are associated with this therapy.
Teriparatide, which is given as a daily subcutaneous injection, is generally reserved for patients with severe postmenopausal osteoporosis (those with more than 2 vertebral fractures). Most of these patients have previously been unresponsive to or intolerant of oral bisphosphonates.
- Hugh Taggart, MD
Consultant Physician
Belfast City Hospital
Northern Ireland
Primary Viewpoints Episode 7: Antidepressants for Back Pain, Osteoarthritis Pain
February 25th 2021Listen to our newest podcast episode where the lead author of a recent meta-analysis shares his findings on the safety and efficacy of antidepressant medications to treat back and osteoarthritis pain.
Podcast: Arthritis, Anxiety, and Depression: Managing a Common Comorbidity
May 14th 2012Anxiety is even more common than depression among people who have arthritis, a new study has shown. Here to discuss the implications for diagnosis and treatment is Eilzabeth Lin MD, a family medicine physician who is a longstanding researcher in the field of depression and pain.