Rx Note

Introduction The World Health Organization (WHO) classifies low bone mineral density (BMD) according to T-score as either osteoporosis or osteopenia ; these definitions only apply to BMD measurements taken at the lumbar spine, total hip or femoral neck. Normal = -1 or higher Osteopenia = Between -1 and -2.5 Osteoporosis = -2.5 or lower Osteoporosis occurs most commonly in postmenopausal women, men over 50 years, and in patients taking long-term oral corticosteroids (glucocorticoids). Definitions: The T-Score is the number of standard deviations by which a patient's BMD varies from the young adult mean for their sex , as measured by dual energy X-ray absorptiometry (DXA). The Z-Score is the number of standard deviations a person's BMD varies from the age- and sex-matched mean BMD . Z-scores are recommended for reporting BMD in premenopausal women, men younger than 50 years and children. Management Conservative management (i.e. lifestyle changes) Address inadequate calcium i...

Introduction The vast majority of patients occasionally miss a dose of their medication. Hence, it seems logical to counsel patients on what to do about a missed dose at the time of dispensing. General Advice In general, always look first in the manufacturer's Patient Information Leaflet (PI) or Consumer Medicine Information (CMI) . They may have a section entitled "What to do if you miss a dose". If the information is not available, you may then follow: If the dose is less than 2 hours late, take the missed dose as soon as they remember, and resume the next dose at usual time. If the dose is more than 2 hours late, the advice depends on how often the medicine is taken. If taken once or twice a day, patient should usually take the dose as soon as they remember as long as the next dose is not due within a few hours. Patients should then continue taking the medicine at the usual times. If taken more often than twice a day, it is usually safer to omit the missed dose, and...

Introduction Bisphosphonates (antiresorptive medications) are first-line therapy used for prevention and treatment of osteoporosis . Options include alendronate (oral), ibandronic acid (oral or IV), pamidronate (IV), risedronate (oral), zoledronic acid (IV). Oral Dosage Alendronate: 10 mg daily or 70 mg once a week Ibandronic acid: 150 mg once monthly Risedronate: 5 mg daily or 35 mg once a week or 150 mg once monthly Method of Administration Oral bisphosphonates bioavailability is less than 1% and is greatly decreased with concomitant food and beverages. Each oral tablet should be taken in the morning with at least 6 oz (180 ml) of plain water (not coffee, juice, mineral water, or milk) at least 30 minutes (60 minutes for oral ibandronate) before consuming any food, supplements, or medications. An exception is delayed-release risedronate, which is administered immediately after breakfast with at least 4 oz (120 ml) of plain water. Missed Dose Management If patient misses a weekl...