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BNSSG Adult Joint Formulary
6.4 Disorders of bone metabolism
Last edited: 04-09-2024
6.4 Drugs affecting bone metabolism
First line drugs |
Second line drugs |
Specialist drugs |
Secondary care drugs |
- See NICE TA464 which partially updates TA160 and TA161
- See NICE TA161 on alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women
- See Local guidelines available regarding osteoporosis management and drug holidays located in the Endocrine System guidelines page
Bisphosphonates
Recommended: (TLS Green)
Alendronic acid
- Dispersible alendronic acid is non-formulary
Alternatives: (TLS Blue)
Risedronate
- NICE TA160 Primary prevention of osteoporotic fragility fractures in postmenopausal women
Specific indications:
Disodium pamidronate (TLS Red)
- Hypercalcaemia of malignancy
- Osteolytic lesions & bone pain in bone metastases and Paget's disease
Ibandronic acid 3mg injection (TLS Red)
- Treatment of osteoporosis in those patients who cannot tolerate oral bisphosphonates and zoledronic acid is contraindicated
Ibandronic acid 2mg injection (TLS Red)
- Hypercalcaemia of malignancy in patients with severe renal impairment (<30mL/min)
Ibandronic acid 50mg tablet (TLS Amber 3 months)
Ibandronic acid 150mg tablet (TLS Blue)
- For the treatment of osteoporosis in postmenopausal women at increased risk of fracture when first line alendronate or risedronate are not tolerated
Sodium clodronate (Loron® or Clasteon®) (TLS Amber Specialist Initiated)
- Hypercalcaemia of malignancy, bone metastases in breast cancer
Sodium clodronate (Clasteon® or Loron®) (TLS Red)
- Bone related complications of Myeloma
Zoledronic acid (TLS Red)
- Hypercalcaemia of malignancy
- Prevention of skeletal related events in patients with advanced prostate malignancy involving bone
- Consultant Rheumatologist and Specialists in Osteoporosis in those patients who cannot tolerate oral bisphosphonates or where there are compliance issues e.g. cognitively impaired elderly patients
- For use in Early Breast Cancer in Postmenopausal women during chemotherapy requiring secondary care attendance
Bone Formation Stimulants
Calcitonins
Recommended: (TLS Red)
Calcitonin salmon (salcatonin) injection
Specific indication: (TLS Red)
Teriparatide
Monoclonal Antibodies
Specific indications:
Denosumab (TLS Amber 3 months)
Denosumab (TLS Red)
- NICE TA265 For prevention of skeletal related events in adults with bone metastases from solid tumours (not including prostate cancer)
- See also Guide for adding Denosumab to EMIS Web
Denosumab (TLS Red)
- For treatment of malignant hypercalcaemia resistant to bisphosphonates
- Unlicensed
Romosozumab (TLS Red)
- NICE TA791 Romosozumab for treating severe osteoporosis
Parathyroid hormone
Specific indication: (TLS Red)
Teriparatide
- NICE TA161 Secondary prevention of osteoporotic fragility fractures
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