Table 2.
Adverse reactions to treatments in osteoporosis
| Prevalence | Strength of association | Consistency of association | Dose–response | Temporality | Biological plausibility | |
|---|---|---|---|---|---|---|
| Bisphosphonates | ||||||
| GI effects (oral formulations) | Common (≥1/100) | ++ | ++ | + | + | + |
| Musculoskeletal pain | Common (≥1/100) | + | + | − | + | − |
| Acute-phase reactions (IV formulations) | Common (≥1/100) | ++ | ++ | + | + | + |
| Atrial fibrillation | Very rare (<1/10,000) | − | − | − | − | − |
| Atypical fracture/delayed fracture healing | Very rare (<1/10,000) | ± | − | − | + | + |
| Osteonecrosis of the jaw | Very rare (<1/10,000) | − | − | − | − | + |
| Hypersensitivity reactions | Very rare (<1/10,000) | + | + | − | + | − |
| Renal impairment | Very rare (<1/10,000) | + | + | + | + | + |
| Denosumab | ||||||
| Severe infection | Common (≥1/100) | + | + | − | + | + |
| Osteonecrosis of the jaw | Very rare (<1/10,000) | − | − | − | − | + |
| Cancer | Very rare (<1/10,000) | − | − | − | − | − |
| SERMs | ||||||
| Hot flushes | Very common (>1/10) | ++ | ++ | + | + | + |
| Leg cramps | Common (≥1/100) | + | + | + | + | + |
| Venous thromboembolism | Uncommon (≥1/1,000 to <1/100) | + | + | + | + | + |
| Stroke | Very rare (<1/10,000) | − | − | − | − | − |
| Endometrial effects | Very rare (<1/10,000) | + | + | + | + | + |
| Strontium ranelate | ||||||
| Venous thromboembolism | Very rare (<1/10,000) | + | − | − | − | − |
| Hypersensitivity reactions | Very rare (<1/10,000) | + | − | − | + | − |
| Teriparatide or PTH(1–84) | ||||||
| Headache, nausea, dizziness, and limb pain | Common (≥1/100) | + | + | + | + | + |
| Osteosarcoma | Very rare (<1/10,000) | − | − | − | − | ± |
++ strong evidence, + evidence, ± mixed evidence, − no evidence