Oral bisphosphonates as the therapy of choice in patients with moderate risk of fractures

Abstract

Nowadays clinicians have access to high-quality diagnostic algorithms to determine the risk of fractures and the need for treatment, as well as the ability to choose the most advanced drug therapy that will be the most suitable, comfortable and safe for the patient with osteoporosis. This algorithm for the selection of therapy is based on an assessment of the fracture risk, which is determined by the presence and severity of low-energy fractures, the level of bone mineral density (BMD), and the 10-year probability of fractures. Patients with a moderate risk of osteoporotic fractures are the most controversial category of patients regarding the choice and assessment of the prognosis of treatment, since they either have no history of fractures or have suffered only one low-energy fracture due to osteopenia or normal BMD. In such cases, oral bisphosphonates with a planned treatment duration of 5 years were recommended as starting therapy for osteoporosis. Alendronic acid is the most well-known and widely prescribed oral bisphosphonate, characterized by financial availability and a favorable profile of clinical efficacy in the treatment of osteoporosis. The effectiveness of treatment with oral bisphosphonates is largely determined by the tolerability of the drug and patient adherence to treatment. Gastrointestinal side effects and the lack of patient motivation are the main reasons for the low adherence to anti-osteoporotic therapy. Due to the low incidence of adverse events and the convenient pharmacological form for enhancing treatment compliance, alendronate buffer solution in soluble effervescent tablets may be preferred in patients with a moderate risk of fractures. Solubilized in a buffer solution alendronate less contacts the mucous membrane of the esophagus and stomach, minimizing contact between the particles of the drug and the mucous membrane of the upper gastrointestinal tract, and ultimately reducing the local irritating effect and the likelihood of gastroesophageal reflux.