Question
A 65-year-old man comes to the physician for hematemesis and progressive heartburn over the past 5 days. Ten days ago, he was started on a medication to treat a condition that causes hearing difficulties and pain of the lower legs. He has no other history of serious illness. He has smoked 1 pack of cigarettes daily for the past 20 years. Physical examination shows bowing of the tibias. Upper endoscopy shows inflammation of the mucosa and a 1-cm punched-out ulcer in the distal esophagus. Which of the following drugs is the most likely cause of the patient’s current condition?
| A. |
Calcium citrate
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| B. |
Denosumab
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| C. |
Risedronate
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| D. |
Calcitonin
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Show Answer
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Correct Answer � C
Explanation
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Ans-C-Risedronate
Calcium citrate
Calcium citrate may be given as a supplement to prevent hypocalcemia and secondary hyperparathyroidism in Paget disease of bone. However, calcium citrate is not associated with esophagitis.
Denosumab
Denosumab inhibits osteoclasts and reduces bone resorption. It is administered as a subcutaneous injection to treat osteoporosis. Denosumab is not currently recommended for use in Paget disease of bone, and it is not associated with esophagitis.
Risedronate
This patient’s drug-induced esophagitis is most likely due to oral bisphosphonate therapy (e.g., risedronate). Bisphosphonates, which inhibit osteoclast-mediated bone resorption, are the first-line treatment for Paget disease of the bone. Oral bisphosphonates may cause erosive esophagitis and esophageal cancer, especially in patients who do not maintain an upright posture for 30–60 minutes after ingestion. Other side effects of bisphosphonates (both IV and oral) include aseptic osteonecrosis of the jaw, atypical femoral fractures, hypocalcemia, and hypophosphatemia. IV bisphosphonates (e.g., zoledronate) may cause an acute-phase reaction with flu-like symptoms 24–72 hours after administration.
Calcitonin
Calcitonin reduces bone resorption and disease activity in Paget disease of bone. Because it is less effective than the first-line treatment, it is only used if the first-line therapy is poorly tolerated. Calcitonin is administered as a subcutaneous injection and does not cause esophagitis.
