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Practice Point
Bone-modifying agents – Treatment considerations
Before commencing treatment with a bone-modifying agent (denosumab or zoledronic acid) discuss the benefits, common and rare side effects, risks (including unknown harms to future offspring) and regulatory status of the treatments.
Discuss the benefits and risks of bisphosphonate treatment with women, particularly the risk of osteonecrosis of the jaw, atypical femoral fractures, and osteonecrosis of the external auditory canal. Follow the Medicines and Healthcare products Regulatory Agency/Commission on Human Medicines (MHRA/CHM) advice on bisphosphonates.
How this guidance was developed
This recommendation was adapted from the NICE 2018 guidelines (UK). The source recommendation was based on a systematic review of the evidence conducted to September 2017 and used wording indicative of the need for shared decision-making by the source guideline authors. The source recommendation was adapted by including denosumab as well as the bisphosphonate zoledronic acid, and expanding the topics for discussion.
Bone-modifying agents – Treatment considerations
Practice Point
Before commencing treatment with a bone-modifying agent (denosumab or zoledronic acid) discuss the benefits, common and rare side effects, risks (including unknown harms to future offspring) and regulatory status of the treatments.
Principles in action
Patient-centred care
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Discuss out of pocket costs
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Safe and quality care
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Communication
This recommendation was adapted from the NICE 2018 guidelines (UK). The source recommendation was based on a systematic review of the evidence conducted to September 2017 and used wording indicative of the need for shared decision-making by the source guideline authors. The source recommendation was adapted by including denosumab as well as the bisphosphonate zoledronic acid, and expanding the topics for discussion.