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Bisphosphonates

Bisphosphonates are used in the prevention and treatment of postmenopausal osteoporosis and some are approved for the treatment of osteoporosis in men. They can help prevent fractures of the spine, hip, and wrist in people with osteoporosis and prevent bone loss for men and women taking steroids.

Bisphosphonates work by slowing cells that break down bone (osteoclasts) allowing cells that build bone (osteoblasts) more time to work and reduce the imbalance. Etidronate (Didronel®) was the first bisphosphonate used clinically in the United States and has been approved for the treatment of Paget’s disease, but not for osteoporosis. Fosamax® and Actonel® received FDA approval in the mid-1990s and are also approved for the treatment of osteoporosis in men. More recently, Boniva® (ibandronate), Reclast® (zolendronic acid), and Generic Fosamax (alendronate) were added to bisphosphonate arsenal.

There are many ways to take a bisphosphonate. Weekly or monthly oral doses are available, and Recast is a yearly infusion. These treatments may be different in their chemical make-up, but their mechanism of action is the same. Patients and their doctors should discuss the options based on dosing, cost or convenience.

Brands
Weekly dosing

  • Actonel® (risedronate)
  • Fosamax® (alendronate)
  • Generic Fosamax (alendronate) approved by FDA in 2008
  • Boniva® (ibandronate)

Monthly dosing

  • Actonel® (risedronate)
  • Boniva® (ibandronate)

Yearly dosing

  • Reclast® (zolendronic acid) infusion

The published side effects of bisphosphonates may include muscle aches, joint aches, stomach upset or heartburn. In a small number of cases (1 in 1,000) osteonecrosis of the jaw (ONJ) or atypical fractures have been reported.

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