Tiludronate

INTRODUCTION

Indications

Management of Paget's disease of the bone in patients with Serum alkaline phosphatase ≥2 times the upper limit of normal, Symptoms, Risk for complications.

Action

Inhibits resorption of bone by inhibiting osteoclast activity. Therapeutic Effects: ↓ progression of Paget's disease.

Adverse Reactions/Side Effects

CNS: anxiety, drowsiness, fatigue, insomnia, nervousness, syncope, vertigo, weakness. EENT: cataracts, conjunctivitis, glaucoma, pharyngitis, rhinitis, sinusitis. Resp: bronchitis. CV: chest pain, dependent edema, hypertension, peripheral edema. GI: abdominal pain, anorexia, constipation, diarrhea, dry mouth, dysphagia, esophageal ulcer, esophagitis, flatulence, gastric ulcer, gastritis, nausea, tooth disorder, vomiting. GU: urinary tract infection. Derm: flushing, increased sweating, pruritus, rash, skin disorder. Endo: hyperparathyroidism. F and E: hypocalcemia. MS: musculoskeletal pain, arthrosis, involuntary muscle contractions, osteonecrosis (primarily of jaw), pathological fractures. Neuro: paresthesia. Misc: infection.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess any joint pain, muscle pain, or muscle spasms. Report persistent or increased musculoskeletal pain to determine presence of bone or joint pathology, including fracture. Be especially aware of possible mouth and jaw pain due to osteonecrosis of the jaw.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).

• Assess vertigo, syncope, and drowsiness that might affect gait, balance, and other functional activities. Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess signs of paresthesia (numbness, tingling) or muscle twitching. Perform objective tests, including electroneuromyography and sensory testing, to document any drug-related neuropathic changes.

• Monitor neuromuscular signs of low calcium levels (hypocalcemia), including headache, lethargy, weakness, cramping, and muscle hyperexcitability and tetany. Notify physician immediately if these signs occur.

• Be alert for signs of hyperparathyroidism, including excessive urination, fatigue, malaise, mental symptoms (depression, forgetfulness), GI problems (abdominal pain, nausea, vomiting, loss of appetite), kidney stones, and fragile bones. Report these signs to the physician.

• Monitor and report anxiety, nervousness, or other changes in mood and behavior.

Interventions

• Institute weight-bearing and resistance exercises as tolerated to maintain or increase bone mineral density. Start with low impact or aquatic programs in patients with extensive demineralization, and increase exercise intensity slowly to prevent fractures.

• Protect against falls and fractures (See Appendix E). Modify home environment (remove throw rugs, improve lighting, etc.) and provide assistive devices (cane, walker) or other protective devices as needed to improve balance and prevent falls.

Patient/Client-Related ...