• Clinical science

Bisphosphonates

Abstract

Bisphosphonates (e.g., etidronate, alendronate) are used for the treatment of hypercalcemia and bone metabolism disorders, such as osteoporosis or tumor-induced osteolysis. All bisphosphonates primarily slow down the degradation of bone substance by interfering with osteoclast function. However, nitrogen-containing bisphosphonates work by a different molecular pathway than simple bisphosphonates and have a stronger effect. Important side effects of bisphosphonate therapy include hypocalcemia, renal impairment, and aseptic osteonecrosis of the jaw. Therefore, bisphosphonates are contraindicated in patients with hypocalcemia and those with a limited glomerular filtration rate (GFR). Additionally, oral bisphosphonates may cause esophageal damage while IV bisphosphonates can induce flu-like symptoms.

Effects

The nitrogen-containing bisphosphonates have a stronger effect than the simple bisphosphonates!

Bisphosphonates also reduce bone formation since bone resorption and formation are intrinsically connected! However, bone resorption is reduced more severely than bone formation!

References:[1][2][3][4][5][6]

Side effects

Bisphosphonates should be taken in the morning with sufficient water and in an upright position at least 60 minutes before eating!

References:[2][7][8][9][10]

We list the most important adverse effects. The selection is not exhaustive.

Indications

References:[2]

Contraindications

  • Reduced GFR (< 30–35 ml/min)
  • Hypocalcemia
  • Esophageal abnormalities (e.g., strictures)
  • Pregnancy/lactation period: no clear contraindications, individual risks/benefits must be weighed

References:[11]

We list the most important contraindications. The selection is not exhaustive.