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Osteoporosis Treatment With Bisphosphonate

Bisphophonates are a widely used class of drugs that prevent bone loss by inhibiting the cells that break down bone. Since their first introduction to clinical medicine over 20 years ago, they have revolutionized the treatment of osteoporosis, a debilitating disease in which bones become weaker and tend to fracture. They are also important treatments in other bone-related diseases including Paget's disease, bone metastasis and multiple myeloma.

  1. Osteoporosis

    • Bone is living tissue that constantly renews itself via cells that build bone, osteoblasts, and cells that break it down, osteoclasts. Osteoporosis develops over time when the bone destruction activity of osteoclasts exceeds the synthetic activity of the osteoblasts. Over time, the bones become thin and prone to fracture, typically in the hip, spine and wrist. According to the National Osteoporosis Foundation, osteoporosis affects over 44 million Americans. Women are four times more likely than men to develop the disease.

    Bisphosphonates

    • Bisphosphonates are a class of drugs that prevent the loss of bone mass by inhibiting the osteoclasts that break down bony tissue. This prevents the development of osteoporosis. The group includes Fosamax, Boniva and Actonel, which are usually taken by mouth daily, weekly or monthly. Reclast was the first bisphosphonate approved by the FDA for once-yearly intravenous treatment of osteoporosis. Boniva is also available in an intravenous form. Fosamax is the only bisphosphonate currently available as a generic.

    Safety and tolerability of bisphosphonates

    • Bisphosphonates are generally well tolerated with limited toxicity, in part because they bind selectively to their target tissue, bone. When taken by mouth, bisphosphonates can cause heartburn, esophageal irritation, abdominal pain and other gastrointestinal effects. To reduce esophageal irritation, individuals should take their pills in the morning before eating or drinking, in an upright position. In rare cases, serious problems with bone healing in the jaw, termed osteonecrosis of the jaw, occur in individuals taking bisphosphonates. This occurs more frequently in cancer patients, especially after dental surgery.

    Future developments

    • Future developments with bisphosphonates include development of more potent compounds, evaluation in combination with other existing treatments, and long-term monitoring of treated patients.

    Conclusion

    • The burden of osteoporosis on American society is immense and continues to grow as the population ages. Since their introduction, the bisphosphonate drugs have become the standard of care for millions of patients with osteoporosis, and it seems certain the drugs will remain an important component of disease management for the foreseeable future.

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