TOLERABILITY OF ORAL PAMIDRONATE IN ELDERLY PATIENTS WITH OSTEOPOROSIS AND OTHER METABOLIC BONE-DISEASES

Oral pamidronate (APD) is being used increasingly in the treatment of a variety of bone diseases. In a retrospective chart review of patient s at three research centers (a 558.3 patient-year sample), the side ef fects of treatment with oral, low-dose APD administered in enteric-coa ted, soft gelatin capsules were analyzed in a group composed primarily of elderly women with osteoporosis, Although 21.8% of the patients ex perienced various gastrointestinal side effects, 89.1% complied with t he treatment schedule. Among patients who discontinued therapy, two ha d duodenal ulcerations and one had hemorrhagic gastritis, There was a statistically significant negative correlation (r < -.90) between dura tion of treatment and rate of side effects; this correlation was influ enced by patients who discontinued treatment early because of side eff ects. No clear dose-effect relationship could be demonstrated. No diff erences were detected when patients concomitantly received calcium, vi tamin D, or any other nonosteotrophic drug, such as vasodilators or an tiarrhythmic drugs, Hematologic abnormalities, including a reversible decrease in leukocyte count, were noted in 9.4% of the 635 patient cha rts that contained this type of data, This phenomenon is gradual and a ppears to be different from the sudden hematologic manifestation of th e acute reaction phase described with intravenous administration of AP D, Thus it may be concluded that oral APD administered to elderly pati ents for approximately 1 year would be expected to cause gastrointesti nal side effects in about 21.8% of patients and the gradual progressio n of hematologic side effects in about 9.4%.