Comparison of Bisphosphonates for Treatment of Osteoporosis

Your doctor might prescribe bisphosphnates for osteoporosis.

Bisphosphonate drugs are usually the first line of prevention and treatment for osteoporosis. However, oral bisphosphonates are not safe for everyone. According to Dr. J.P. Jansen in the August, 2009 issue of Current Medical Research and Opinion, the injectable zoledronic acid is the most effective bisphosphonate for preventing fractures.

Significance

The National Institute of Arthritis and Musculoskeletal Disease states that approximately 10 million Americans suffer from osteoporosis. Prevention and treatment both involve slowing bone loss to prevent fractures. Exercise, diet and drugs can all prevent and treat osteoporosis.

Bisphosphonate Drugs

Bisphosponate drugs increase bone density and reduce the risk of fractures. The bisphosphonates alendronate and risedronate are taken orally. Ibandronate can be taken orally or by intravenous injection. Zoledronic acid is injected intravenously.

Considerations

Oral bisphosponates are not for everyone.

Oral bisphosphonates (alendronate, risedronate and possibly ibandronate) must be taken early in the morning on an empty stomach. They can irritate your esophagus. If you suffer from heartburn or nausea, have difficulty swallowing or have a problem with your esophagus or stomach, you should not take oral bisphosphonates.

Comparisons

In the August, 2009 issue of Current Medical Research and Opinion, Dr. J.P. Jansen reported that intravenous injection of zoledronic acid decreased the number of fractures in post-menopausal women better than the other bisphosphonates. Zoledronic acid also worked better than risedronate for men with steroid-induced osteoporosis, according to a study by Dr. D.M. Reid in the April, 2009 issue of The Lancet journal. However, Dr. Reid reported that zoledronic acid caused more side effects, including worsening rheumatoid arthritis.

Warning

There are some counter-indications for taking bisphosponates.

Intravenous bisphosphonates might cause jaw damage (osteonecrosis). If you have serious kidney disease, are pregnant or nursing, or have low calcium levels in your blood, you should not take bisphosphonates. Instead, ask your doctor about other drugs to treat osteoporosis.

References

• Merck Manuals: Osteoporosis
• "Current Medical Research and Opinion" journal; Prevention of Vertebral Fractures in Osteoporosis: Mixed Treatment Comparison of Bisphosphonate Therapies; JP Jansen et al; August 2009
• "The Lancet" journal; Zoledronic Acid and Risedronate in the Prevention and Treatment of Glucocorticoid Induced Osteoporosis (HORIZON)-A Multicentre, Double-Blind, Double-Dummy, Randomised Controlled Trial; D.M. Reid et al; April 2009

Resources

• National Institute of Arthritis and Musculoskeletal Disease: Osteoporosis