Bisphosphonates

Question 1

Which are the Bisphosphonates?

Answer 1

Etidronate Sodium (Didronel®) - No longer used
Alendronate Sodium (Fosamax®)
Pamidronate Disodium (Aredia®)
Risedronate Sodium (Actonel®)
Zolendronate (Zometa®) (Reclast ®)
Ibandronate (Boniva®)
Tiludronate disodium (Skelid) - no longer used

Question 2

What are the characteristics of the Bisphosphonates?

Answer 2

● Side Effects: Diarrhea and GI upset,
● Nephrotoxicity with etidronate if
given IV
● Fever and flu­ like symptoms upon first
IV infusion
● esophageal ulcerations and
esophagitis (needs to be taken with a full glass of plain water at least 30 min before first food, beverage or other drug of the day; then avoid lying down)
● osteonecrosis of the jaw (specifically with alendronate and zolendronate)
● atrial fibrillation (more prevalent in women) → a. fib. and jaw osteonecrosis has been hypothesized to be due to possible inhibition of matrix metallo­proteinase­2
● Clinical uses: Paget’s disease, hypercalcemia, osteoporosis

Question 3

What are the characteristics of Etidronate Sodium (Didronel®)?

Answer 3

● Considered 1st generation
● Can’t  use IV ( nephrotoxic )
● More equal inhibition of both
OC and OB function which is a
disadvantage
● Doesn’t contain nitrogen
● Seldomly used

Question 4

What are the characteristics of Alendronate Sodium (Fosamax®)?

Answer 4

● 2nd generation
● Making liquid preparation to
cause less esophageal erosion
● At low doses  = highly selective
inhibitor of bone resorption

Question 5

What are the characteristics of Pamidronate Disodium (Aredia®)?

Answer 5

● 2nd generation

● IV only

Question 6

What are the characteristics of Risedronate Sodium (Actonel®)?

Answer 6

● 2nd generation
● More potent, so need smaller
amount, so there may be (?) less esophageal SE’s

Question 7

What are the characteristics of Zolendronate (Zometa®) (Reclast ®)?

Answer 7

● Most potent agent
● A single 5­mg infusion
decreases bone turnover for 6 months with no loss of
therapeutic effect

Question 8

What are the characteristics of Ibandronate (Boniva®)?

Answer 8

● Dosed once ­a ­month