Greater Risk For Uveitis, Scleritis, And Other Ocular Side Effects According To Two Recent Medical Journal Articles

(Posted by Tom Lamb at DrugInjuryWatch.com)

Fosamax, Boniva, and other osteoporosis medications in the bisphosphonates drug class have been linked to osteonecrosis of the jaw (ONJ) and atypical femur fractures, with both of these side effects getting considerable coverage in the popular press for some years now.

In early April 2012 there appeared two medical journal articles which brought attention to a lesser known and relatively new set of side effects associated with drugs like Boniva and Fosamax which involve not the bones but the eyes.

First, according to a retrospective cohort study in the Canadian Medical Association Journal (CMAJ), "Inflammatory ocular adverse events with the use of oral bisphosphonates: a retrospective cohort study", we learned that first-time use of oral bisphosphonates is associated with greater risk for two inflammatory eye diseases, uveitis and scleritis.

This CMAJ article by Mahyar Etminan and his collegues, concludes with these three important practical points:

• Bisphosphonate-induced uveitis and scleritis are potentially reversible conditions, if there is early intervention by an ophthalmologist.
• The risk of inflammatory ocular adverse events, including scleritis and uveitis, is not highlighted in most package inserts included with oral bisphosphonates.
• Patients taking oral bisphosphonates must be familiar with the signs and symptoms of these conditions, so that they can seek immediate assessment by an ophthalmologist.

Next, from the Orbit medical journal, "Bisphosphonate-associated orbital inflammation-a case report and review". From the Abstract for that article:

Several ocular side effects due to bisphosphonates have been described, among the most potentially serious of which is orbital inflammation. Thirteen case reports of this side effect exist in the literature, with an additional case reported here. The most common presenting signs are lid edema, conjunctival hyperemia, and chemosis, while common symptomatology includes pain, diplopia, and blurry vision. A concomitant anterior uveitis is present in 30% of cases, and some degree of bilaterality is also seen in 30% of cases. There are two reported instances of profound visual loss, highlighting the importance of prompt recognition and treatment of this entity.

We will continue to monitor this new set ocular or vision side effects associated with the bisphosphonate drugs like Boniva and Fosamax.

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