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PubMed2000

[Esophageal lesions associated with diphosphonates].

BACKGROUND: Bisphosphonates are potent inhibitors of osteoclast-mediated bone resorption and effective in preventing osteoporotic fractures, but they can occasionally cause oesophageal adverse events. MATERIAL AND METHODS: We report on seven patients who developed severe oesophagitis or oesophageal ulceration during treatment with bisphosphonates. They were registered at our endoscopy unit during a 31-month period. RESULTS: Six of the patients took alendronate (Fosamax) and one etidronate (Didronate). The oesophageal lesions heal on discontinuation of the bisphosphonate. Institution of gastric acid suppression treatment may enhance the healing process. INTERPRETATION: In order to minimise the risk of serious side-effects, it is important to give detailed instructions regarding medication and to ensure that the instructions are properly understood. The risk of serious complications can be reduced by early recognition of oesophageal symptoms and appropriate intervention.

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PubMed2003

[Psychiatric side effects associated with diphosphonate treatment].

Two women aged 50 and 64 years, respectively, and one man aged 43 years, were treated with cyclic etidronic acid for osteoporosis. After some months/years they developed mood, concentration and memory problems. The complaints diminished within several weeks after withdrawal of the drugs, and reappeared after rechallenge. Two of these patients had similar complaints during the use of another bisphosphonate (pamidronic acid and alendronic acid, respectively). Bisphosphonates are used increasingly frequently for the treatment of osteoporosis. Generally, these drugs are well tolerated. The most frequently reported adverse events are gastrointestinal complaints and oesophageal ulcers. Psychiatric complaints also appear to be a rare side effect.

Adult↗
PubMed1992

[A phosphine-substituted diphosphonic acid (HMPD) for improved scintigraphic detection of bone lesions].

Although the radiopharmaceuticals used for bone scintigraphy are of very high quality, the search for an "ideal" agent continues. To optimise the detectability of bone lesions, we analysed 244 different 99mTc-labeled phosphonates in animal experiments. In osteosarcoma-carrying rats 99mTc-labeled 1-Hydroxy-3-methyl-phosphinic-1, 1-propanediphosphonic acid (HMPD) was shown to produce the best lesion/normal bone ratio. 99mTc-MDP was used as reference. The ratio was found to be 1.28 for 99mTc-HMPD. The transferability of our results in animals to the situation in man was studied in 10 patients with bone metastases. There was for 99mTc-HMPD an improvement of the lesion/normal bone ratio by more than 60% but also an additional reduction of the soft tissue contrast by about 40%. 15% of the metastases were detected by scintigraphy using 99mTc-HMPD only and not with 99mTc-MDP. The new agent should make possible a better and earlier discrimination of bone lesions in the scintigram.

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