Bisphosphonates in osteoporosis
Bisphosphonates are compounds characterized by a P-C-P structure. They act essentially on bone, inhibiting bone resorption. Through this mechanism they decrease bone loss, increase bone mineral density, and decrease bone turnover. They are therefore administered in diseases with elevated bone destruction, such as Paget’s disease, metastatic bone disease, and osteoporosis. In the latter they diminish both vertebral and nonvertebral fractures. The adverse events are few, mostly gastrointestinal, and can be avoided to a large extent by correct administration. Since there are no other compounds available which have a similar profile, they represent today the drugs of choice in the treatment and the secondary prevention of osteoporosis.
KeywordsBisphosphonates Etidronate Alendronate Risedronate Osteoporosis
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- 1.Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE (1996) Randomized trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 348:1535–1541PubMedGoogle Scholar
- 6.Fleisch H (2000) Bisphosphonates in bone disease — from the laboratory to the patient. Academic, San DiegoGoogle Scholar
- 11.Liberman UA, Weiss SR, Bröll J, Minne HW, Quan H, Bell NH, Rodriguez-Portales J, Downs RW Jr, Dequeker J, Favus M, Seeman E, Recker RR, Capizzi T, Santora AC II, Lombardi A, Shah RV, Hirsch LJ, Karpf DB (1995) Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. N Engl J Med 333:1437–1443CrossRefGoogle Scholar
- 16.Neer N, Arnaud CD, Zanchetta JR, Prince R, Gaich, GA, Reginster YI, Hodsman AB, Erichsen EF, Ish-Shalom S, Genant HK, Wang O, Mitlak, BH (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1444PubMedGoogle Scholar
- 17.Pols HAP, Felsenberg D, Hanley DA, Stepan J, Munoz-Torres M, Wilkin TJ, Qin-sheng G, Galich AM, Vandormael K, Yates AJ, Stych B (1999) Multinational, placebo-controlled, randomized trial of the effects of alendronate on bone density and fracture risk in postmenopausal women with low bone mass: results of the FOSIT study. Osteoporos Int 9:461–468PubMedGoogle Scholar
- 19.Rogers MJ (2003) New insights into the molecular mechanisms of action of bisphosphonates. Curr Pharmaceut Design (in press)Google Scholar
- 20.Roussouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J, Writing Group for the Women’s Health Initiative Investigators (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 288:321–333PubMedGoogle Scholar
- 22.Schenk R, Merz WA, Mühlbauer R, Russell RGG, Fleisch H (1973) Effect of ethane-1-hydroxy-1:1-diphosphonate (EHDP) and dichloromethylene diphosphonate (Cl2MDP) on the calcification and resorption of cartilage and bone in the tibial epiphysis and metaphysis of rats. Calcif Tissue Res 11:196–214PubMedGoogle Scholar
- 23.Schnitzer T, Bone HG, Crepaldi G, Adami S, McClung M, Kiel D, Felsenberg D, Recker RR, Tonino RP, Roux C, Pinchera A, Foldes AJ, Greenspan SL, Levine MA, Emkey R, Santora AC, Kaur A, Thompson DE, Yates J, Orloff JJ (2000) Therapeutic equivalence of alendronate 70mg onceweekly and alendronate 10mg daily in the treatment of osteoporosis. Aging Clin Exp Res 12:1–12Google Scholar
- 24.Tonino RP, Meunier PJ, Emkey RD, Rodriguez-Portales JA, Menkes CJ, Wasnich RD, Bone HG, Santora AC, Wu M, Desai R, Ross PD (2000) Skeletal benefits of alendronate: 7-year treatment postmenopausal osteoporotic women. Phase III osteoporosis treatment study group. J Clin Endocrinol Metab 85:3109–115CrossRefPubMedGoogle Scholar
- 26.Watts NB, Harris ST, Genant HK, Wasnich RD, Miller PD, Jackson RD, Licata AA, Ross P, Woodson GC, Yanover MJ, Mysiw WJ, Kohse L, Rao MB, Steiger P, Richmond B, Chesnut CH III (1990) Intermittent cyclical etidronate treatment of postmenopausal osteoporosis. N Engl J Med 323:73–329PubMedGoogle Scholar