How to Treat Osteoporosis With Infusion
Osteoporosis is a musculoskeletal disease which affects the bones. The bones in the human body regrow and restructure through a person's lifetime, but when the rate of bone mineral loss exceeds the rate of mineral absorption, the condition is known as osteoporosis. The National Osteoporosis Foundation reports 10 million Americans have this disease, of which 80 percent are women. Women are at high risk for this disease because their estrogen levels decrease after menopause, which causes a reduction in the rate of bone regrowth.
The Novartis Pharmaceuticals Corporation reported in 2009 that the Food and Drug Administration approved a zoledronic acid-based drug, Reclast, to be administered to postmenopausal patients with osteoporosis via intravenous (IV) infusions. Similar drugs, such as Zometa, work to strengthen bones to prevent future fractures.
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Things You'll Need
- DXA machine
- IV administration set with vent
- IV catheter
- Tourniquet
- Alcohol pad
- 2" x 2" gauze sponge
- adhesive tape
- extension set and saline syringe
- Reclast or Zometa
- water
- vitamin-D and/or calcium supplements
- reading material/music
Instructions
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For Patients
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1
Check your bone mineral density (BMD). Your doctor will use dual energy x-ray absorptiometry (DXA) to measure your bone density. According to the National Osteoporosis Foundation, a BMD test can predict the likelihood of fracture or detect the onset of osteoporosis. A BMD measures where in the body bone density levels are low or bone minerals are diminishing.
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2
Review the results with your doctor to find out whether intravenous infusion treatment is necessary. Schedule an appointment as needed. Depending on the drug your doctor suggests, you may have to come in for one yearly visit (Reclast), or a visit every three to four weeks (Zometa).
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3
Drink plenty of fluids on the day of treatment. Both Reclast and Zometa professionals suggest at least two glasses before going in for treatment, because it helps flush out the kidneys. Eat normally before treatment.
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4
Take supplemental calcium and vitamin D every day between treatments. According to the Zometa website, patients should take a 500-milligram oral calcium tablet and a multiple vitamin containing 400 international units (10 micrograms) of vitamin D daily. According to Reclast dosage and infusion instructions, those calcium doses should be administered two to three times a day, and they suggest 800 to 1,000 international units (20 to 25 micrograms) of vitamin D daily.
For Doctors
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5
If the BMD test indicates that the patient needs treatment, check that the patient's creatinine clearance is no less than 35 milliliters per minute.
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6
Advise the patient to drink plenty of fluids and eat normally on the day of her infusion treatment. Advise the patient to begin or continue taking vitamin D or calcium supplements.
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7
On the day of treatment, check the patient's vital signs before beginning infusion. Also make sure the patient does not show signs of dehydration, such as saggy skin, pale complexion, dry mouth, low urine output or weight loss.
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8
Check serum creatinine. According to Zometa clinical trials, for a patient with normal baseline creatinine, an increase of 0.5 milligrams per deciliter is unacceptable. For a patient with abnormal baseline creatinine, an increase of 1.0 milligram per deciliter is unacceptable. These are signs of renal deterioration and the patient cannot proceed to infusion treatment.
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9
Once cleared, find an IV point of access in the patient's arm, using a saline lock for additional security.
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10
If you're administering Reclast, dilute 5 milligrams in a 100 milliliters ready-to-infuse solution. For Zometa, dilute 4 milligrams. Infuse the drug at a constant rate of 33 drops per 15 seconds for 15 minutes.
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Remove the IV and check the patient's point of access for swelling or redness. Dispose of infusion treatment materials safely.
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12
Warn the patient of side effects such as fever, dehydration, pain at IV access site and/or muscle pain. Advise the patient to drink plenty of water and to continue taking calcium and vitamin D supplements.
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Tips & Warnings
Patients, take something to read or listen to during your 15-minute infusion treatment so you can relax.
Doctors should only prescribe one infusion drug to patients because both Zometa and Reclast utilize the same active ingredient, zoledronic acid. Infusion treatment alone will not strengthen bones. Side effects include muscle pain, flu-like symptoms, and tenderness at point of access. Patients who show signs of renal deterioration should not be prescribed to infusion treatment, because it can further endanger the kidneys. Doctors should not prescribe infusion treatment for pregnant women.
