Ocular side effects of bisphosphonates: A case report and literature review.

Osteoporosis carries a high burden of illness, both for individual patients and society. In addition to substantial health care system costs, osteoporosis-associated fractures cause pain, disability, and increased risk of institutionalization. An estimated 50% of Canadian women older than 80 years of age meet diagnostic criteria for osteoporosis.1 Family physicians work with patients to prevent and treat osteoporosis on a daily basis. The current mainstay of treatment for osteoporosis is therapy with bisphosphonates, a class of drugs that inhibit osteoclast-mediated bone resorption and that have been shown to be effective for increasing bone density and decreasing risk of fracture.2 In addition to their use in osteoporosis, bisphosphonates are used to treat Paget disease, hypercalcemia, and bone metastases. While generally well tolerated, bisphosphonates can cause side effects such as nausea, dyspepsia, abdominal pain, muscle aches, and headaches.3 These side effects are annoying and can affect adherence, but they do not generally cause permanent injury. With widespread use of bisphosphonates in large populations, certain rare but serious potential side effects (such as osteonecrosis of the jaw)4 have emerged in postmarketing surveillance. Recently, surveillance data have identified a link between certain ocular side effects and bisphosphonate use. This article describes a case in which a patient experienced chronic conjunctivitis while using oral bisphosphonates. In order to better understand the nature of ocular side effects and to inform family physicians about their diagnosis and management, a comprehensive literature search from 1980 to December 2009 on MEDLINE and EMBASE was performed, using search terms bisphosphonates, eye diseases, adverse effects, adverse drug reactions, chemically induced, and side effects.