RESUMEN

Oral bisphosphonates are effective medications for the prevention of fractures in people suffering from osteoporosis. They are associated with gastrointestinal adverse reactions the most severe being an esophageal ulcer. It is unclear if oral bisphosphonates have a similar gastrointestinal safety profile in the hospital setting as in the community setting because hospitalized patients are often bedridden which may hinder proper drug administration. INTRODUCTION: To evaluate the incidence of upper gastrointestinal symptoms in hospitalized patients taking oral bisphosphonate. METHODS: This single-center prospective cohort study included hospitalized adult patients actively taking risedronate or alendronate. Upper gastrointestinal symptoms were actively assessed at the baseline and 1 to 5 h following the administration of the oral bisphosphonate. RESULTS: A total of 298 patients were included in the study. The mean age was 64 ± 15 years. During the follow-up period, gastric and esophageal symptoms affected 32 patients (10.7%). Epigastric burning, dysphagia, and regurgitation were reported in 4.4% (n = 13), 3% (n = 9), 2.7 (n = 8), and 2.3% (n = 7) patients, respectively. Heartburn, retro-sternal pain, and odynophagia were observed in 1.7% (n = 5), 1.7% (n = 5), and 0.3% (n = 1) patients. CONCLUSION: The incidence of adverse reaction was similar to that reported in community trials. The administration of oral bisphosphonate in hospitalized patients does not represent an additional risk for upper gastrointestinal adverse events. Treatment should be optimized during the hospital stay to improve the pharmacological management of osteoporosis.

Asunto(s)

Conservadores de la Densidad Ósea , Difosfonatos , Osteoporosis , Administración Oral , Adulto , Anciano , Alendronato/efectos adversos , Conservadores de la Densidad Ósea/efectos adversos , Difosfonatos/efectos adversos , Humanos , Pacientes Internos , Persona de Mediana Edad , Osteoporosis/tratamiento farmacológico , Osteoporosis/epidemiología , Estudios Prospectivos , Ácido Risedrónico/uso terapéutico

RESUMEN

Recurrent upper gastrointestinal (UGI) and cardiovascular (CV) events of the three antiplatelet therapies in patients with cardiovascular diseases (CVD) were compared. Studies published in the PubMed, Embase, and Cochrane Central Register of Controlled Trials electronic databases that compared differences in adverse outcomes associated with the three antiplatelet therapies were reviewed. Five studies with a total number of 7,399 patients were included. No significant differences were found in the incidence of recurrent UGI events among the three antiplatelet therapies. However, in the aspirin-induced ulcer bleeding subgroups, aspirin plus proton pump inhibitors (PPIs) was associated with a significantly lower risk of recurrent UGI events (OR: 0.06, 95% CI: 0.01-0.32; z=3.30 and P=0.001) and UGI bleeding (OR: 0.06, 95% CI: 0.01-0.34; z=3.24 and P=0.001) compared to clopidogrel alone. Both aspirin plus PPIs (OR: 2.12, 95% CI: 1.58-2.84; z=5.00 and P<0.01) and clopidogrel plus PPIs (OR: 2.57, 95% CI: 1.89-3.51; z=5.97 and P<0.01) were related to a comparatively higher risk of recurrent CV events when compared to clopidogrel alone. In patients at high UGI bleeding risk (regardless of whether it was aspirin-induced) and under treatment of single antiplatelet therapy, aspirin plus PPIs should be considered as the first choice for UGI protection rather than clopidogrel alone and clopidogrel plus PPIs. However, in terms of CV protection, clopidogrel alone appears to be superior in reducing CV risk, while clopidogrel plus PPIs may relate to an increased CV risk due to the potential drug-drug interaction.