Bisphosphonates: New Indications and Methods of Administration

Ian R. Reid, MD

Disclosures

Curr Opin Rheumatol. 2003;15(4) 

In This Article

Abstract and Introduction

In the course of 2002, several new studies were published confirming the efficacy of bisphosphonate drugs in fracture prevention in patients with osteoporosis. Further evidence was provided of their long duration of action, making intermittent administration possible. The potent bisphosphonate zoledronate can be given at intervals of as long as 1 year and produces changes in bone density and in markers of bone turnover comparable with those seen with conventional daily oral dosing with alendronate or risedronate. If such regimens are proven to prevent fractures, their convenience is likely to result in their widespread adoption and potentially an increase in compliance with these medications. Further evidence has been presented documenting the value of bisphosphonates in preventing the skeletal complications of malignancy, and possibly in reducing mortality in patients with breast cancer. The role of bisphosphonates in osteogenesis imperfecta was further confirmed, and novel roles in ankylosing spondylitis, myelofibrosis, and hypertrophic pulmonary osteoarthropathy were suggested.

The bisphosphonates had a low-key entry to clinical practice when etidronate was introduced as the therapy for Paget disease of bone in the 1970s. It was not until the end of that decade that their true potential was signaled by two reports from Olav Bijvoet's group[1] published in The Lancet. These articles described the much more potent bisphosphonate pamidronate and demonstrated its efficacy in treating hypercalcemia of malignancy and Paget disease. Although this agent was used increasingly for these indications during the 1980s, it was not until the publication of the first positive randomized controlled trial of a bisphosphonate in the management of osteoporosis[2] that this new indication opened for this class of drugs. The 1990s saw enormous progress in this field. The bisphosphonates went from being experimental agents at the beginning of the decade to becoming the treatments of choice for osteoporosis, Paget disease, hypercalcemia of malignancy, and some other skeletal complications of malignancy by the decade's end.

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