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Treatment of osteoporosis: recognizing and managing cutaneous adverse reactions and drug-induced hypersensitivity

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Abstract

Summary

Cutaneous adverse reactions are reported for many treatments including antiosteoporotic agents. This position paper includes an algorithm for their recognition. With early recognition and proper management, including immediate and permanent withdrawal of the culprit agent, accompanied by hospitalization, rehydration, and systemic corticosteroids, if necessary, the prognosis is good.

Introduction

Cutaneous adverse reactions are reported for many therapeutic agents and observed in between 0% and 8% of treated patients depending on the drug. The antiosteoporotic agents are reputed to be safe in terms of cutaneous effects; however, there have been a number of case reports of cutaneous adverse reactions, which merit consideration. This was the subject of a Working Group meeting of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis in April 2009, to focus on the impact of cutaneous adverse reactions and drug-induced hypersensitivity in the management of postmenopausal osteoporosis. We prepared this position paper following these discussions, and include an algorithm for their recognition.

Methods

We reviewed cutaneous adverse reactions observed with antiosteoporotic agents, including information from case reports, regulatory documents, and pharmacovigilance.

Results

The cutaneous adverse reactions range from benign reactions including exanthematous or maculopapular eruption (drug rash), photosensitivity, and urticaria to the severe and potentially life-threatening reactions, angioedema, drug rash with eosinophilia and systemic symptoms (DRESS), Stevens Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). Review of available evidence shows that cutaneous adverse reactions occur with all commonly used antiosteoporotic agents. Notably, there are reports of SJS and TEN for bisphosphonates, and of DRESS and TEN for strontium ranelate. These severe reactions remain very rare (<1 in 10,000 cases).

Conclusion

With early recognition and proper management, including immediate and permanent withdrawal of the culprit agent, accompanied by hospitalization and rehydration and systemic corticosteroids if necessary, the prognosis is good.

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Conflicts of interest

Professor P. Musette is a consultant/advisor for Servier.

Professor M-L Brandi has no conflict of interest for this manuscript.

Professor P. Cacoub has disclosed that he has been the recipient of research grants from Schering Plough, Roche, Servier, and Gilead; that he has received honoraria from Roche, Servier, Bristol Myers Squibb, Sanofi Aventis, Gilead, and Schering Plough; and that he is a consultant/advisor to Roche, Servier, Bristol Myers Squibb, Sanofi Aventis, and Gilead Schering Plough.

Doctor J-M Kaufman has no conflict of interest.

Doctor R. Rizzoli has disclosed that he is a consultant/advisor to Merck, Roche, Servier, Danone, Nycomed, Eli Lilly, and Amgen; and that he is on the Speakers' Bureau for Roche, Novartis, Servier, and Amgen.

Professor J-Y Reginster has disclosed that he has been the recipient of research grants from Bristol Myers Squibb, Merck Sharp and Dohme, Rottapharm, Teva, Lilly, Novartis, Roche, GlaxoSmithKline, Amgen, and Servier; that he is a consultant/advisor to Servier, Novartis, Negma, Lilly, Wyeth, Amgen, GlaxoSmithKline, Roche, Merckle, Nycomed, NPS, Theramex, and UCB; and that he has been the recipient of lecture fees for speaking at meetings on behalf of Merck Sharp and Dohme, Lilly, Rottapharm, IBSA, Genevrier, Novartis, Servier, Roche, GlaxoSmithKline, Teijin, Teva, Ebewee Pharma, Zodiac, Analis, Theramex, Nycomed, and NovoNordisk.

Author information

Authors and Affiliations

  1. Department of Dermatology and INSERM Unit 905, Charles Nicolle University Hospital, Rouen, France

    P. Musette

  2. Department of Internal Medicine, University of Florence, Florence, Italy

    M. L. Brandi

  3. Department of Internal Medicine, AH-HP, Hôpital Pitié Salpétrière, and Université Pierre et Marie Curie, Paris 6, Paris, France

    P. Cacoub

  4. UZ Gent Department of Internal Medicine, Ghent, Belgium

    J. M. Kaufman

  5. Geneva University Hospitals, Geneva, Switzerland

    R. Rizzoli

  6. Department of Public Health Sciences, University of Liège, Liège, Belgium

    J.-Y. Reginster

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  1. P. Musette
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  2. M. L. Brandi
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Correspondence to J.-Y. Reginster.

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Musette, P., Brandi, M.L., Cacoub, P. et al. Treatment of osteoporosis: recognizing and managing cutaneous adverse reactions and drug-induced hypersensitivity. Osteoporos Int 21, 723–732 (2010). https://doi.org/10.1007/s00198-009-1097-5

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  • DOI: https://doi.org/10.1007/s00198-009-1097-5

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