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Author: Admin | 2025-04-28
Bisphosphonates have proved to be ineffective erectile dysfunction drugs dosage cheap tadala black 80 mg online. It is indicated for patients with endstage renal disease with secondary hyperparathyroidism refractory to standard treatment. Calcium-based phosphate binders, such as calcium carbonate and calcium acetate, are the most commonly used agents with similar efficacy. Newer non calcium-based phosphate binders include the anion exchange resins sevelamer hydrocholoride and sevelamer carbonate. These have a similar phosphate lowering effect compared to calcium based agents but are associated with reduced risk of hypercalcaemia. Sevelamer hydrochloride may worsen metabolic acidosis thus sevelamer carbonate is the preferred agent. Lanthanum carbonate is a non-aluminium, non-calcium-based phosphate binder with similar efficacy to calcium-based phosphate binders. There are fewer data from good quality, large clinical trials evaluating lanthanum; short-term trials suggest increased adverse effects compared with other binders. Phosphate binders alone may not be sufficient to control phosphate levels and prevent secondary hyperparathyroidism. Note that vitamin D analogues, by increasing intestinal phosphate absorption, can worsen hyperphosphataemia. Because of the increase in serum calcium and phosphate that can occur with vitamin D therapy, cinacalcet is preferred in patients with serum phosphate or calcium levels at the upper limit of normal. Osteomalacia Osteomalacia is due to primary or secondary vitamin D deficiency (see above). The newer nitrogen-containing bisphosphonates (pamidronate, zoledronic acid, risedronate, alendronate) are the agents of choice. These bisphosphonates suppress bone turnover without impairing bone mineralisation. Alendronate and risedronate are administered orally whereas pamidronate and zoledronic acid are given intravenously. Their response is dose related and biochemical remission (normalisation of alkaline phosphatase) after a course may last for up to 2 years. Calcitonin (which also inhibits bone resorption) has been largely superseded by the bisphosphonates but retains usefulness because it reduces bone blood flow before surgery. This prevents free radicals from attacking polyunsaturated
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