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Revista de la Sociedad Española del Dolor

versión impresa ISSN 1134-8046


VIDAL, M. A.; MEDINA, C.  y  TORRES, L. M.. Safety of bisphosphonates. Rev. Soc. Esp. Dolor [online]. 2011, vol.18, n.1, pp.43-55. ISSN 1134-8046.

Bisphosphonates are widely indicated, and most therapies using bisphosphonates are given long-term, which has favored the emergence of new associated adverse effects -- maxillary osteonecrosis (MON), severe pain, atypical fractures, stomatitis, and inflammatory eye disorders. The goal of this paper is to review the current safety status of these drugs, and to describe the newly emerging adverse effects. Bisphosphonates may be divided up into two types according to their chemical structure and mechanism of action, as the presence or absence of nitrogen in their molecule entails differences in power. No tests are available that allow an identification of patients at higher risk for developing MON in order to adopt appropriate preventive measures. The causal relationship of bisphosphonates with atypical fractures could not be demonstrated, but their prescription is recommended in patients recovering from recent fractures. Nor is there any evidence that bisphosphonates may induce bone, muscle, or joint pain, but consideration must be given to the fact that pain subsides on most occasions upon bisphosphonate therapy discontinuation. No definite conclusions can be drawn to establish a causal relationship between bisphosphonate use and increased risk for AF. The presence of other risk factors should be taken into account, and patients should be surveilled on an individual basis for the potential emergence of heart rhythm disturbances. The actuality of a higher risk for esophageal cancer in association with the use of bisphosphonates could not be confirmed. However, the FDA recommends that oral bisphosphonates should not be prescribed for patients with Barrett's esophagus.

Palabras clave : Bisphosphonates; Maxillary osteonecrosis; Muscular pain; Bone pain; Joint pain; Atrial fibrillation; Uveitis; Esophageal cancer.

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