- Goals of Therapy for the Patient
- Prescribed Drug Therapy
- Parameters for Monitoring the Success of the Therapy
- Specific Patient Education Based on the Prescribed Therapy
- Adverse Reactions ABL and ALN
- OTC or Alternative Medicines Appropriate J.S
- Dietary and Lifestyle Changes
- Drug-Drug or Drug-Food Interactions for the Selected Agent
- References
Goals of Therapy for the Patient
The primary goal of this therapy is to improve bone mineral density (BMD). In postmenopausal women, there is an association between lumbar BMD and lumbar disc degeneration (LDD), which is more pronounced in the upper lumbar spinal regions (Zhou et al., 2022). J.S. is 72-year-old, recently had a hysterectomy and is not on any hormonal intervention; thus, she is at risk of low BMD. Additionally, the adverse effect may be associated with the treatment of osteoporosis. Therefore, it is necessary to address them to avoid any complications.
Prescribed Drug Therapy
The best drug recommended for this patient is abaloparatide (ABL), followed by alendronate (ALN). Administering ABL and ALN has proven to provide the best results in women over the age of 80 (Greenspan et al., 2020). ABL is crucial in this case due to its human parathyroid hormone-related protein (PTHrP). Essentially, this will be a quick hormone replacement therapy for J.S. Instructions should be followed while under this medication to avoid potential adverse effects.
Parameters for Monitoring the Success of the Therapy
The success of the therapy can be monitored in the long term by checking the overall improvement in BMD. Studies show that the risk of severe osteoporotic fractures considerably decreases after 18 months of ABL administration due to enhanced BMD (Greenspan et al., 2020). Other metrics like joint pains and tenderness can be assessed. Additionally, J.S. underwent a hysterectomy; therefore, evaluating how well the hormone therapy worked is crucial. The management of these conditions is vital to avoid future complications and hormonal imbalance.
Specific Patient Education Based on the Prescribed Therapy
The patient should be informed of the drug’s efficacy, safety and adverse effects. Consecutive treatment with 18 months of ABL followed by ALN is supported by the safety and effectiveness evidence (Greenspan et al., 2020). Therefore, J.S. need to adhere to this prescription to avoid medication misuse. Additionally, it is crucial to teach J.S. about the potential drug-drug or drug-supplement interactions. Finally, any negative side effects, such as headaches and gastrointestinal problems, must be mentioned.
Adverse Reactions ABL and ALN
ABL and ALN may also result in unwanted outcomes besides their necessary effects. In the ABL/ALN medication, musculoskeletal discomfort, dyspepsia, sciatica, and back pain are more frequent based on studies (Greenspan et al., 2020). While not all of these side effects are likely to materialize, if they do, medical attention may be necessary. Overall, patients who have ever experienced an unusual or adverse reaction to this medication or any other medication should immediately let the doctor know.
OTC or Alternative Medicines Appropriate J.S
OTC medicine like calcium citrate is appropriate for this patient. According to LeBoff et al. (2022), adequate calcium intake is required to develop peak bone mass and preserve bone health throughout a person’s lifetime. Cholecalciferol (vitamin D3) can be recommended as an alternative supplement for J.S. When calcium and vitamin D are provided at prescription doses, anti-fracture efficacy rises. Generally, these drugs increase bone density, lessen bone loss and significantly lower the frequency of fractures.
Dietary and Lifestyle Changes
The patient should avoid activities with a high risk of falling due to weak bones. Additionally, the patient needs to partake in meals with increased quantities of calcium and vitamin D. Given that ALN’s recognized side effects can cause people to become worried, calcium is a safer option for long-term use (Shaalan et al., 2020). Increased calcium consumption can help bones in several ways, especially considering how few side effects it has. Finally, the patient should avoid taking wine as this may impact the absorption of these drugs.
Drug-Drug or Drug-Food Interactions for the Selected Agent
ABL and ALN produce a positive interaction mechanism when used correctly. Sequential anabolic medication accompanied by antiresorptive therapy may accomplish the treatment objective of raising and preserving BMD, lowering the risk of further fractures (Greenspan et al., 2020). Nonetheless, it is crucial to note that ALN should be used with caution because calcium intake reduces the intestinal absorption of the drug. The common side effects are linked to overusing ALN or taking other medications simultaneously.
References
Greenspan, S. L., Fitzpatrick, L. A., Mitlak, B., Wang, Y., Harvey, N. C., Deal, C., Cosman, F., & McClung, M. (2020). Abaloparatide followed by alendronate in women ≥80 years with osteoporosis: Post hoc analysis of ACTIVExtend.Menopause, 27(10), 1137-1142.
LeBoff, M. S., Greenspan, S. L., Insogna, K. L., Lewiecki, E. M., Saag, K. G., Singer, A. J., & Siris, E. S. (2022). The clinician’s guide to prevention and treatment of osteoporosis.Osteoporosis International, 1-54.
Shaalan, A. A., El-Sherbiny, M., El-Abaseri, T. B., Shoaeir, M. Z., Abdel-Aziz, T. M., Mohamed, M. I., Zaitone, S. A., & Mohammad, H. M. (2020). Supplement with calcium or Alendronate suppresses osteopenia due to long term Rabeprazole treatment in female mice: Influence on bone TRAP and Osteopontin levels.Frontiers in Pharmacology, 11, 1-11.
Zhou, L., Li, C., & Zhang, H. (2022). Correlation between bone mineral density of different sites and lumbar disc degeneration in postmenopausal women. Medicine, 101(13), 1-6.