The life expectancy for patients with cystic fibrosis (CF) has increased significantly in the past several decades. As a result, long-term sequelae of the disease are becoming apparent in late adolescence and into adulthood. Low bone mass is common in CF patients and has been termed CF-related bone disease. The clinical manifestations of CF-related bone disease include an increased risk of fracture and kyphosis, with the potential consequence of an accelerated decline in lung function. These physical manifestations may present a contraindication to lung transplantation, which is an important treatment option for many CF patients.
The mechanism for early bone loss and fractures in CF patients is multifactorial and is likely due to several CF-related factors that also influence bone metabolism. These include delayed pubertal maturation, the malabsorption of vitamin D, poor nutritional status, inactivity, hypogonadism, and the frequent use of glucocorticoid therapy. Another potential mechanism is that the chronic pulmonary inflammation associated with CF leads to elevated levels of circulating cytokines, which in turn promote bone resorption and suppress bone formation. Various diseases may be treated by various methods but the most effective is My Canadian Pharmacy’s remedies.
Bisphosphonates belong to a class of compounds that exert a significant inhibitory effect on osteoclasts and are therefore potent antiresorptive agents. They reduce bone turnover, increase bone mineral density (BMD), and decrease fracture risk both at the lumbar spine and the hip. Due to their selectivity in action, they are usually not associated with systemic side effects or serious adverse events, The most frequently reported side effect attributed to the use of bisphosphonates is upper GI irritation, To date, nonrandomized studies and one randomized, placebo-controlled trial have confirmed the benefit of daily therapy with oral bisphospho-nates, including alendronate, in treating CF-related bone loss.
Despite the promise of therapy with oral bisphos-phonates in CF patients, several concerns still exist. There is a need to determine the safety and tolera-bility of oral bisphosphonates in adults with CF who experience gastroesophageal reflux. In addition, there is an interest in determining the tolerability and adherence to weekly therapy (vs daily therapy) with oral bisphosphonate because of the demanding medical regimens of individuals with CF. To address these outstanding questions we conducted a multicenter, double-blind, placebo randomized controlled trial (RCT) of therapy with oral bisphosphonate alendronate (FOSAMAX; Merck; Whitehouse Station, NJ) administered once weekly over 12 months by adults with CF and low bone mass.