Aims: Bisphosphonates are the recommended initial therapy for osteoporosis management (1). IV bisphosphonates (IVBP) have several benefits including reduced dosing, improved adherence (2) and reduced gastrointestinal side-effects. Clinicians may be wary of prescribing IVBP due to concerns of an acute phase response (APR), a common side-effect characterised by fever, pain, GI upset and malaise, which can impact adherence to further infusions (3). There are no clear guidelines on management of APRs and establishing expert practice can help better inform patient care. This project’s aim is to identify common prescribing practices for therapies to reduce/treat APRs to facilitate creation of a suggested prescribing regimen.
Methods: A survey was distributed to members of Australian Rheumatology Association (ARA) and Endocrine Society of Australia (ESA) asking if they prescribe IVBP, their prescribing protocol for prevention/treatment of APRs and whether they found it significantly impacted the incidence/severity of APRs.
Results: 27 respondents completed the survey with 26 regularly prescribing IVBP, with a wide range of prescribing protocols for both prophylaxis and treatment. 19.2% reported APRs may impact their decision to prescribe IVBP. All respondents used paracetamol though 53.8% felt it didn’t impact the likelihood/severity of APRs. 46.1% used NSAIDs but 66.6% of these found they did not impact the likelihood/severity of APRs. 80.7% used corticosteroids and 90.5% of these found it did impact the likelihood/severity of APRs.
Conclusions: Management of APRs is varied and would benefit from further study. Based on expert opinion, corticosteroids do appear to impact the frequency/severity of APRs.