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6.6 Drugs affecting bone metabolism

6.6 Drugs affecting bone metabolism

Management of Patients Receiving Treatment with Bisphosphonates 

     Treatment of Osteonecrosis of the Jaw  
     RED    Pentoxyfylline tablets (off licence use, consultant use only) 
     RED    Vitamin E tablets (off licence use, consultant use only) 
    Osteoporosis occurs most commonly in postmenopausal women and in those taking long-term oral corticosteroids 
    (glucocorticosteroids). Other risk factors for osteoporosis include low body weight, cigarette smoking, excess alcohol intake, lack 
    of physical activity, family history of osteoporosis, and early menopause. 
 Those at risk of osteoporosis should maintain an adequate intake of calcium and 

vitamin D and any deficiency should be corrected by increasing dietary intake or taking supplements.

     See section for calcium and 9.6.4 for vitamin D replacement, and section 6.4.1 for raloxifene.
     NICE TA265 -  Denosumab for the prevention of skeletal-related events in adults with bone metastases from solid tumours.
     Denosumab is recommended as an option for preventing skeletal-related events (pathological fracture, radiation to bone, spinal
     cord compression or surgery to bone) in adults with bone metastases from breast cancer and from solid tumours other than
     prostate if:
               >     bisphosphonates would otherwise be prescribed and  
               >     the manufacturer provides denosumab with the discount agreed in the patient access scheme.
     RED                 Denosumab injection pre-filled syringe 120mg (XGEVA®)
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