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Orthopedics Case No 4.Osteoprosis Bisphosphonate or ibandronic acid.

Ibandronic Acid হচ্ছে Bisphosphonate শ্রেণির একটা মেডিসিন- Osteoporosis এ Osteclastic activity বেড়ে যায়, Bones থেকে Calcium বের হয়ে যায়, Bones pain হয়, Bones fragile হয়ে এক সময় ভেংগে যায়-

তাই Dexa scan এ osteoporosis diagnosis হলে Bones protection এর জন্য Bisphosphonate দেওয়া হয়- সাথে ক্যালসিয়াম +ভিটামিন ডি সাপ্লিমেন্টারী দেওয়া হয়,

Bisphosphonate এর মধ্যে কয়েক প্রকার মেডিসিন আছে-

first line হচ্ছে- Drug hosse

Alendronic Acid (Bonemas 10 mg/70 mg) নামে পাওয়া যায়, Bonemas 10 mg প্রতিদিন একটা করে খেতে হয়, আর Bonemas-70 mg meekly একটা খেলে হয়, সাথে Calcium +vitamine D supplementary চলবে-

Tablet 1:Alendon 70 mg( As a Alendronic Acid As A Bisphosphonate preparations).

Indications of Tablet- :Alendon 70 mg( As a Alendronic Acid As A Bisphosphonate preparations):-

Alendon is indicated for the-

  • Treatment of Osteoporosis in Postmenopausal Women: Alendon is indicated for the treatment of osteoporosis in postmenopausal women. In postmenopausal women, Alendon increases bone mass and reduces the incidence of fractures, including those of the hip and spine.
  • Prevention of Osteoporosis in Postmenopausal Women: Alendon is indicated for the prevention of postmenopausal osteoporosis.
  • Treatment to Increase Bone Mass in Men with Osteoporosis: Alendon is indicated for treatment to increase bone mass in men with osteoporosis.
  • Treatment of Glucocorticoid-Induced Osteoporosis: Alendon is indicated for the treatment of glucocorticoid-induced osteoporosis in men and women receiving glucocorticoids in a daily dosage equivalent to 7.5 mg or greater of prednisone and who have low bone mineral density.
  • Treatment of Paget’s Disease of Bone: Alendon is indicated for the treatment of Paget’s disease of bone in men and women. Treatment is indicated in patients with Paget’s disease of bone who have alkaline phosphatase at least two times the upper limit of normal, or those who are symptomatic, or those at risk for future complications from their disease.

Pharmacology Indications of Tablet- :Alendon 70 mg( As a Alendronic Acid As A Bisphosphonate preparations):-

 

Alendronate is a bisphosphonate that binds to bone hydroxyapatite and specifically inhibits the activity of osteoclasts, the bone-resorbing cells. Alendronate reduces bone resorption with no direct effect on bone formation, although the latter process is ultimately reduced because bone resorption and formation are coupled during bone turnover.

Animal studies have indicated the following mode of action. At the cellular level, alendronate shows preferential localization to sites of bone resorption, specifically under osteoclasts. The osteoclasts adhere normally to the bone surface but lack the ruffled border that is indicative of active resorption. Alendronate does not interfere with osteoclast recruitment or attachment, but it does inhibit osteoclast activity. Studies in mice on the localization of radioactive [3H] alendronate in bone showed about 10-fold higher uptake on osteoclast surfaces than on osteoblast surfaces. Bones examined 6 and 49 days after [3H] alendronate administration in rats and mice, respectively, showed that normal bone was formed on top of the alendronate, which was incorporated inside the matrix. While incorporated in bone matrix, alendronate is not pharmacologically active. Thus, alendronate must be continuously administered to suppress osteoclasts on newly formed resorption surfaces. Histomorphometry in baboons and rats showed that alendronate treatment reduces bone turnover (i.e., the number of sites at which bone is remodeled). In addition, bone formation exceeds bone resorption at these remodeling sites, leading to progressive gains in bone mass.

Dosage & Administration Indications of Tablet- :Alendon 70 mg( As a Alendronic Acid As A Bisphosphonate preparations):-

 

Treatment of Osteoporosis in Postmenopausal Women: The recommended dosage is one 70 mg tablet once weekly or one bottle of 70 mg oral solution once weekly or one 10 mg tablet once daily.

Prevention of Osteoporosis in Postmenopausal Women: The recommended dosage is one 35 mg tablet once weekly or one 5 mg tablet once daily.

Treatment to Increase Bone Mass in Men with Osteoporosis: The recommended dosage is one 70 mg tablet once weekly or one bottle of 70 mg oral solution once weekly or one 10 mg tablet once daily.

Treatment of Glucocorticoid-Induced Osteoporosis: The recommended dosage is one 5 mg tablet once daily, except for postmenopausal women not receiving estrogen, for whom the recommended dosage is one 10 mg tablet once daily.

Treatment of Paget’s Disease of Bone: The recommended treatment regimen is 40 mg once a day for six months.

Side Effects Indications of Tablet- :Alendon 70 mg( As a Alendronic Acid As A Bisphosphonate preparations):-

 

The commonest symptomatic side effects are constipation, diarrhoea, oesophageal ulcer, flatulence, dysphagia, musculoskeletal pain, headache, rarely rash, erythema, transient decrease in serum calcium and phosphate, nausea, vomiting, peptic ulceration, hypersensitivity reactions including urticaria and angio-oedema.

প্রতিদিন Alendronate /weekly Alendronate খেতে খেতে stomach indigestion হয়, তা ছাড়া প্রতিদিন ঔষধ খাওয়া কষ্টকর, তাই Bisphosphonate এর আরো উন্নত মানের ঔষধ বাজারে আসে -;ibandronic acid নামে

এইটা tab- Ivana 150 mg নামে পাওয়া যায়, এইটার efficacy Alendronate থেকে ভালো, মাসে একটা নিলেই হয়, দাম বেশী, একটা প্রায় ১২০০-২০০০ টাকা পর্যন্ত দাম।

Tablet 2:- Ivana 150 mg (As a ibandronic acid AS A Bisphosphonate preparations)

Indications of Tablet :- Ivana 150 mg (As a ibandronic acid AS A Bisphosphonate preparations):-

Ivana is indicated for the:

  • Treatment of osteoporosis in women (specially postmenopausal)
  • Prevention of osteoporosis in women (specially postmenopausal)
  • Prevention and treatment of osteoporosis in men

Treatment of Osteoporosis: Osteoporosis may be confirmed by the finding of low bone mass (T-score <-2.0 SD) and the presence or history of osteoporotic fracture, or a low bone mass (T-score <-2.5 SD) in the absence of documented pre-existing osteoporotic fracture.

Pharmacology of Tablet :- Ivana 150 mg (As a ibandronic acid AS A Bisphosphonate preparations):-

 

The pharmacodynamic action of ibandronic acid is inhibition of bone resorption. In vivo, ibandronic acid prevents experimentally induced bone destruction caused by cessation of gonadal function, retinoids, tumors or tumor extracts. In young (fast growing) rats, the endogenous bone resorption is also inhibited, leading to increased bone mass compared with untreated animals. Animal models confirm that ibandronic acid is a highly potent inhibitor of osteoclastic activity. In growing rats, there was no evidence of impaired mineralization even at doses greater than 5,000 times the dose required for osteoporosis treatment. The high potency and therapeutic margin of ibandronic acid allows for more flexible dosing regimens and intermittent treatment with long drug-free intervals at comparatively low doses.

Ibandronic acid is a highly potent bisphosphonate belonging to the nitrogen-containing group of bisphosphonates, which act on bone tissue and specifically inhibit osteoclast activity, It does not interfere with osteoclast recruitment. The selective action of ibandronic acid on bone tissue is based on the high affinity of this compound for hydroxyapatite, which represents the mineral matrix of the bone. Ibandronic acid reduces bone resorption, with no direct effect on bone formation. In postmenopausal women, it reduces the elevated rate of bone turnover towards premenopausal levels, leading to a progressive net gain in bone mass. Daily or intermittent administration of ibandronic acid results in reduced bone resorption as reflected in reduced levels of serum and urinary biochemical markers of bone turnover, increased BMD and a decreased incidence of fractures.

Dosage & Administration of Tablet :- Ivana 150 mg (As a ibandronic acid AS A Bisphosphonate preparations):-

The recommended dose of Ibandronic acid for treatment is one 150 mg film-coated tablet once a month. The tablet should preferably be taken on the same date each month. Ibandronic acid should be taken 60 minutes before the first food or drink (other than water) of the day or any other oral medication or supplementation (including calcium):

  • Tablets should be swallowed whole with a full glass of plain water (180 to 240 ml) while the patient is sitting or standing in an upright position. Patients should not lie down for 60 minutes after taking Ibandronic acid.
  • Plain water is the only drink that should be taken with Ibandronic acid. Please note that some mineral waters may have a higher concentration of calcium and therefore should not be used.
  • Patients should not chew or suck the tablet because of a potential for oropharyngeal ulceration. Patients should receive supplemental calcium or vitamin D if dietary intake is inadequate. In case a once-monthly dose is missed, patients should be instructed to take one Ibandronic Acid 150 mg tablet the morning after the tablet is remembered unless the time to the next scheduled dose is within 7 days. Patients should then return to taking their dose once a month on their originally scheduled date. If the next scheduled dose is within 7 days, patients should wait until their next dose and then continue taking one tablet once a month as originally scheduled. Patients should not take two 150 mg tablets within the same week.

Side Effects of Tablet :- Ivana 150 mg (As a ibandronic acid AS A Bisphosphonate preparations):-

 

The main side effects of Ivana are dyspepsia, nausea, diarrhea, abdominal pain, muscle aches, headaches, dizziness.

Osteoporosis এ Bisphosphonate এর ডিউরেশন 6 month to 3 year –

Marincal kit এইটাতে ibandronic acid এর একটা ট্যাবলেট সাথে ক্যালসিয়াম + ভিটামিন ড এর ৬০ টা ট্যাবলেট রয়েছে–

Tablet3:Marincal kid 150 mg+500mg+200IU.

(As a Ibandronic acid+Coral Calcium+Vitamin D3) As A Bisphosphonate preparations.

Indications of Tablet:-Marincal kid 150 mg+500mg+200IU.

(As a Ibandronic acid+Coral Calcium+Vitamin D3) As A Bisphosphonate preparations.

 

This kit is indicated for the treatment and prevention of Osteoporosis. It increases Bone Mineral Density (BMD) and reduces the incidence of vertebral fractures.

Pharmacology of  Tablet:-Marincal kid 150 mg+500mg+200IU.

(As a Ibandronic acid+Coral Calcium+Vitamin D3) As A Bisphosphonate preparations.

 

Ibandronic Acid (Ibandronate Sodium Monohydrate) is a nitrogen- containing bisphosphonate that inhibits osteoclast-mediated bone resorption. The action of Ibandronate on bone tissue is based on its affinity for hydroxyapatite, which is part of the mineral matrix of bone. Ibandronate inhibits osteoclast activity and reduces bone resorption and turnover. In postmenopausal women, it reduces the elevated rate of bone turnover, leading to, on average, a net gain in bone mass.

The combination of Coral Calcium and Colecalciferol is composed of Calcium Carbonate with small amounts of Magnesium and other Trace minerals. Coral Calcium ensures better absorption than Calcium of other Calcium Carbonate origin due to its chemical structure that is very similar to the composition of human bone Calcium Carbonate. Vitamin-D aids in the absorption of Calcium from GI tract and helps to maintain Calcium balance in the body.

Dosage & Administration of  Tablet:-Marincal kid 150 mg+500mg+200IU.

(As a Ibandronic acid+Coral Calcium+Vitamin D3) As A Bisphosphonate preparations.

One tablet of Ibandronic Acid 150 mg once monthly on the same date of each month is recommended. To maximize clinical benefit of Ibandronic acid, two tablets of Calcium 500 mg and Vitamin D3 200 IU per day are usually recommended in divided dosage or as directed by the physician.

Day 1: Take the Ibandronic Acid tablet on an empty stomach at least 60 minutes before the first food or drink (other than water) of the day or before taking any oral medication or supplementation including Calcium, Antacid and/or Vitamins

  • Swallow tablet whole with a glass of plain water while standing or sitting in an upright position
  • Avoid lying down for 60 minutes
  • Do not chew or suck the tablet

Day 2-31: One tablet of Calcium and Vitamin D should be taken at the morning and at the evening after meal

  • Tablets should be taken in order as directed on the blister strip for ease of dose tracking.

Pediatric patient: Safety and effectiveness in pediatric patients have not been established.

Side Effects of  Tablet:-Marincal kid 150 mg+500mg+200IU.

(As a Ibandronic acid+Coral Calcium+Vitamin D3) As A Bisphosphonate preparations.

 

Ibandronic Acid: Common side effects include Hypertension, Dyspepsia, Nausea, Diarrhea, Abdominal Pain, Arthralgia, Back Pain, Localized Osteoarthritis, Myalgia, Muscle Cramp, Influenza, Nasopharyngitis, Bronchitis, Urinary Tract Infection, Upper Respiratory Tract Infection, Headache, Dizziness, Skin rash, Insomnia etc.

Calcium & Vitamin D3: Most common side effects are flatulence, diarrhea, constipation, upper GI discomfort etc. Hypercalciuria and hypercalcemia due to prolong use has rarely been reported.

Osteoporosis এ প্রথম ট্যাবলেট টা খাবে, পরে ৩০ দিন দুই বেলা করে ক্যালসিয়াম সাপ্লিমেন্টারী ট্যাবলেট গুলি খাবে-

এই ভাবে ৬ মাস–

এখানে Marincal এর আলোচনা টা আনলাম এই জন্য যে,

অনেকেই দেখা যায়, osteoarthritis এর চিকিৎসায় পেশেন্ট দের কে এইটা প্রেসক্রাইব করে, যার কোনো ভিত্তি নাই

osteoporosis + osteoarthritis থাকলে দেওয়া যেতে পারে, কেবল মাত্র osteoarthritis এর পেশেন্ট কে Bisphosphonate দেওয়ার কোনো রোল নাই-

Osteoarthritis এর মেকানিজম আর osteoporosis এর মেকানিজম টোটালি আলাদা, তাই এই বিষয় গুলি খেয়াল রাখবেন-

General Quaries:-

Osteoporosis prevention এ tab.alendronate/ibandronateএর চেয়ে inj.zolenic acid এর efficacy কেমন যেহেতু injection টা বছরে ১ বার নিলে হয়

1.Zolenic IV infusion 5mg/100ml. 100ml bottle( As a Zoledronic Acid Bisphosphonate preparations.)

Indications of 1.Zolenic IV infusion 5mg/100ml. 100ml bottle( As a Zoledronic Acid Bisphosphonate preparations.)

Zolenic is indicated in-

  • Treatment and prevention of postmenopausal osteoporosis
  • Treatment to increase bone mass in men with osteoporosis
  • Treatment and prevention of glucocorticoid-induced osteoporosis
  • Treatment of Paget’s disease of bone in men and women

Limitations of Use: Optimal duration of use has not been determined. For patients at low-risk for fracture, consider drug discontinuation after 3 to 5 years of use.

Pharmacology of 1.Zolenic IV infusion 5mg/100ml. 100ml bottle( As a Zoledronic Acid Bisphosphonate preparations.)

 

Zoledronic Acid is a bisphosphonate and acts primarily on bone. It is an inhibitor of osteoclast-mediated bone resorption. The selective action of bisphosphonates on bone is based on their high affinity for mineralized bone. Intravenously administered Zoledronic Acid rapidly partitions to bone and localizes preferentially at sites of high bone turnover. The main molecular target of Zoledronic Acid in the osteoclast is the enzyme farnesyl pyrophosphate synthase. The relatively long duration of action of Zoledronic Acid is attributable to its high binding affinity to bone mineral.

Dosage 1.Zolenic IV infusion 5mg/100ml. 100ml bottle( As a Zoledronic Acid Bisphosphonate preparations.)

 

Treatment of Osteoporosis in Postmenopausal Women: The recommended regimen is a 5 mg infusion once a year given intravenously over no less than 15 minutes.

Prevention of Osteoporosis in Postmenopausal Women: The recommended regimen is a 5 mg infusion given once every 2 years intravenously over no less than 15 minutes.

Osteoporosis in Men: The recommended regimen is a 5 mg infusion once a year given intravenously over no less than 15 minutes.

Treatment and Prevention of Glucocorticoid-Induced Osteoporosis: The recommended regimen is a 5 mg infusion once a year given intravenously over no less than 15 minutes.

Treatment of Paget’s Disease of Bone: The recommended dose is a 5 mg infusion. The infusion time must not be less than 15 minutes given over a constant infusion rate.

Re-treatment of Paget’s Disease: Re-treatment with Zoledronic Acid may be considered in patients who have relapsed, based on increases in serum alkaline phosphatase, or in those patients who failed to achieve normalization of their serum alkaline phosphatase, or in those patients with symptoms, as dictated by medical practice.

Calcium and Vitamin D Supplementation: Instruct patients being treated for Paget’s disease of bone on the importance of calcium and vitamin D supplementation in maintaining serum calcium levels, and on the symptoms of hypocalcemia. All patients should take 1500 mg elemental calcium daily in divided doses (750 mg two times a day, or 500 mg three times a day) and 800 international units vitamin D daily, particularly in the 2 weeks following Zoledronic Acid administration.

Instruct patients being treated for osteoporosis to take supplemental calcium and vitamin D if their dietary intake is inadequate. An average of at least 1200 mg calcium and 800-1000 international units vitamin D daily is recommended.

Side Effects of  1.Zolenic IV infusion 5mg/100ml. 100ml bottle( As a Zoledronic Acid Bisphosphonate preparations.)

 

The most common adverse reactions (greater than 10%) were pyrexia, myalgia, headache, arthralgia, pain in extremity. Other important adverse reactions were flu-like illness, nausea, vomiting, diarrhea, and eye inflammation

Answer is: newa jete pare ..

Raiyyan Tahsan ❤️😜 Date:-27-12-2024 Friday Time:6-15-37 PM

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