Dosing regimens

OP medication dosing regimens vary hugely and it can be more difficult to remember to take something that is prescribed weekly or less often than a daily product, so it is worthwhile helping patients to identify when they are going to take it and how they will set up systems to ensure they don’t forget. For example, writing it on a calendar, setting an audible reminder on a smart speaker, or involving carers or family members.

Bisphosphonates have very specific administration instructions due to the risk of gastrointestinal side-effects when taken orally. The general advice is to take an oral product after an overnight fast and at least 30 minutes before any other medication or first food or drink of the day (other than water).

Tablets should be swallowed whole with a full glass of water (around 200ml) or dissolved in half a glass of water (around 120ml) if effervescent, while the patient stands or sits in an upright position, and they should not lie down for another 30 minutes (an hour for ibandronate). Talking through how this can fit into their morning routine is helpful. Some bisphosphonates are administered intravenously, for which the above is not relevant.

Strontium ranelate should be taken at least two hours after the last meal of the day, so is usually taken at bedtime. The product is available as granules which need to be dissolved in at least 30ml water before being taken.

Denosumab is administered subcutaneously into the thigh, abdomen or upper arm every six months when prescribed for osteoporosis. Only a small number of people self-administer, and only then if enrolled in the manufacturer’s patient support programme.

Missed doses

For all products, a double dose should not be taken to compensate if a dose has been missed. Bisphosphonates, if taken daily, should be continued the next day as usual. The same is true of strontium ranelate. If taken less often, the next tablet should be taken on the day that it is remembered, and then dosing resumed on the day it is normally taken.

Denosumab has some flexibility with dosing, but the benefits can wear off relatively quickly so it is recommended that a missed dose isn’t delayed by more than four weeks.