Esclerite associada ao uso de bisfosfonatos / Scleritis related to the use of bisphosphonates

Alertar para o fato de que os bisfosfonatos, importante classe de drogas utilizada no tratamento da osteoporose, podem causar esclerite. Relatamos caso de uma paciente que apresentou episódio de esclerite durante o uso de alendronato e que recidivou com o uso de outra droga da mesma classe, o risedronato, um ano depois. Os bisfosfonatos constituem uma classe de drogas que tem sido, frequentemente, utilizada no tratamento da osteoporose. No entanto, boa parte da classe médica pode não estar alerta para os efeitos colaterais oculares, tendo em vista que não se encontrou relato desses efeitos na literatura nacional. Este trabalho mostra dois episódios de esclerite, ocorridos em uma mesma paciente, com intervalo de, aproximadamente, um ano, possivelmente, provocados pelo uso de dois tipos de bisfosfonatos. Nas duas ocasiões, houve resposta favorável à suspensão da droga, com a utilização de um tratamento pouco agressivo. Esse fato justificou a não realização da pesquisa de doenças consideradas causas de esclerite, das quais a paciente não apresentava sinais, sintomas, assim como qualquer história pregressa. Tudo isso, associado à existência, na literatura internacional, de relatos de casos de inflamação ocular, inclusive de esclerite, relacionados com o uso dos bisfosfonatos, reforça a hipótese de que os episódios, realmente, tenham sido provocados pelo uso da droga.

To alert to the fact that bisphosphonates, important class of drugs used in the treatment of osteoporosis, can cause scleritis. Report of a female patient's case, who presented an episode of scleritis while using alendronate, and who had one year later another episode during the use of a drug from the same class, risedronate. The bisphosphonates are a class of drugs, which have been used very often in the treatment of osteoporosis. However, a great part of the physicians can not be alert for its ocular side effects, considering that in the national literature there's no report of these effects. This article report two episodes of scleritis, occurred to a patient, in a period of one year, probably caused by the use of two types of bisphosphonates. In these two opportunities, there was recovery after the suspension of the drug, associated with a less aggressive treatment. This fact justified not to perform the search for diseases considered to be the cause of scleritis, of which the patient didn't show any sign, symptom or past clinical history. These facts, associated to the existence of some reports of ocular inflammation, including scleritis, associated to the use of bisphosphonates, reinforces the hypothesis that the episodes, in fact, have been caused by the use of the drug.

Efficacy and safety of risedronate sodium in treatment of postmenopausal osteoporosis / 华中科技大学学报（医学）（英德文版）

To evaluate the efficacy and safety of risedronate sodium in treatment of postmenopausal osteoporosis, one-year randomized, double blind clinical trial was performed among 54 women with postmenopausal osteoporosis. The changes were compared in bone mineral density (BMD), bone metabolism markers and adverse events after 12 months oral administration of risedronate sodium. BMD was measured by dual energy X-ray absorptionmetry (DEXA) and bone turnover marker was detected. The results showed that there was a significant increase in BMD of the lumbar spine (3.29% +/- 1.18%, 4.51% +/- 1.64% respectively) after 6 and 12 months in the risedronate treatment group versus placebo control group (-0.62% +/- 0.24%, 0.48% +/- 0.18% respectively). Bone turnover was decreased to a stable nadir over 6 and 12 months for resorption markers [N-Telopeptide (NTx), P < 0.05] and over 12 months for formation marker (ALP, P < 0.05; BGP, P < 0.05). The safety profile of risedronate sodium was similar to that of placebo. There were no trends toward increased frequency of any adverse experience except for gastrointestinal symptoms (7.1%), rash (7.1%) and hematuria (3.6%), which were usually mild, transient, and resolved with continued treatment. It was concluded that risedronate was an efficacious and safe drug in treatment of postmenopausal osteoporosis.

Comparison of Effect of Treatment with Etidronate and Alendronate on Lumbar Bone Mineral Density in Elderly Women with Osteoporosis

The purpose of this open-labeled prospective study was to compare the treatment effects of cyclical etidronate and alendronate on the lumbar bone mineral density (BMD), bone resorption, and back pain in elderly women with osteoporosis. Fifty postmenopausal women with osteoporosis, age ranging from 55 to 86 years (mean: 70.7 years), were randomly divided into two groups with 25 patients in each group: the cyclical etidronate group (etidronate 200 mg daily for 2 weeks every 3 months) and the alendronate group (5 mg daily). The BMD of the lumbar spine (L1-L4) measured by DXA, the urinary cross-linked N-terminal telopeptides of type I collagen (NTX) level measured by the enzyme-linked immunosorbent assay, and back pain evaluated by the face scale score were assessed at baseline, 6 months, and 12 months. There were no significant differences in baseline characteristics including age, body mass index, years since menopause, lumbar BMD, urinary NTX level, and face scale score between the two treatment groups. Etidronate treatment sustained the lumbar BMD following a reduction in the urinary NTX level and improved back pain, while alendronate treatment reduced the urinary NTX level more significantly, resulting in an increase in the lumbar BMD, and similarly improved back pain. No serious adverse events were observed in either group. This study confirmed that alendronate treatment had a greater efficacy than etidronate treatment in increasing the lumbar BMD through the reduction of bone resorption in elderly women with osteoporosis.

Púrpura vascular alérgica näo-trombocitopênica induzida por etidronato / Non-thrombocytopenic vascular allergic purpura caused by etidronate

É apresentado um caso de púrpura vascular alérgica näo-trombocitopênica induzida por etidronato em uma paciente portadora de osteoporose. Após a suspensäo deste difosfonato (inibidor osteoclástico) houve regressäo completa do quadro dermatológico. Näo foi necessária a corticosteroidoterapia nesta farmacodermia. Acreditamos tratar-se da primeira documentaçäo na literatura médica desta reaçäo atípica de hipersensibilidade ao etidronato.