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Clinicians report varied approaches to managing IV bisphosphonate-associated acute phase responses in osteoporosis, with corticosteroids showing the highest perceived benefit.
A pilot survey of Australian geriatricians, endocrinologists and rheumatologists finds that although paracetamol is the most commonly prescribed option for intravenous bisphosphonate (IVBP)-associated acute phase responses (APRs), clinicians report greater perceived benefit with corticosteroids.
IVBPs are characterized by symptoms such as fever, chills, headache, fatigue, and musculoskeletal pain. The absence of definitive guidance on optimal APR prophylaxis and treatment may contribute to differences in prescribing practices. Against this background, the study aimed to assess clinicians’ use of supplementary therapies for APR prevention or management and their perceived benefits.
Researchers conducted an online survey among members of Australian professional societies representing geriatrics, rheumatology, and endocrinology. Of approximately 2,900 eligible members, 75 clinicians responded, including 68 who prescribed IVBP for osteoporosis. The survey showed that APRs were commonly encountered among clinicians prescribing IVBP, while prescribing practices and perceived treatment benefits varied (Table 1).
However, the perceived benefit differed markedly between therapies (Table 2).
Nevertheless, corticosteroid prescribing was rarely routine. Notably, 94% (34/36) of clinicians who used corticosteroids reported prescribing them on a case-by-case basis, suggesting that treatment decisions were largely individualized. The survey highlights a practical challenge in osteoporosis care: clinicians are actively tackling IVBP-associated APRs, yet approaches vary considerably. Paracetamol was the most widely used intervention, but only half of clinicians using it reported perceiving a benefit. Corticosteroids, although used less frequently, received the strongest positive assessment from clinicians who prescribed them.
Australasian Journal on Ageing
Assessing Clinician Prescribing Practices for Prophylaxis and Treatment of Acute Phase Responses Following IV Bisphosphate Infusions for Osteoporosis: A Pilot Survey-Based Study
Stephen Sweeney et al.
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