Bisphosphonates for the treatment of osteoporosis

Bisphosphonate	Formulations	Dosing	Vertebral fracture reduction	Hip fracture reduction	Nonvertebral fracture reduction	Discontinuation of therapy (in selected patients*); after:
Alendronate	Oral^¶	10 mg once daily, or 70 mg once weekly^Δ	Yes	Yes	Yes	5 years
Risedronate	Oral, immediate release^¶	5 mg once daily, or 35 mg once weekly, or 150 mg once monthly	Yes	Yes	Yes	5 years^◊
Risedronate	Oral, delayed-release (enteric-coated)^§	35 mg once weekly	Yes	Yes	Yes	5 years^◊
Zoledronic acid	Intravenous	5 mg once every 12 months	Yes	Yes	Yes	3 years
Ibandronate	Oral^¶	150 mg once monthly	Yes	No	+/–	Limited data
Ibandronate	Intravenous	3 mg every 3 months	Yes	No	+/–	Limited data

Refer to UpToDate clinical topic reviews for detail on appropriate use of these agents. Dosing in this table is for adult patients with normal kidney function.

* For patients at low risk for fracture in the near future (eg, stable bone density, no previous vertebral or hip fractures), we suggest discontinuing therapy to reduce potential risks of long-term therapy, as there appears to be residual fracture benefit post-treatment.
¶ Most oral bisphosphonates should be taken alone on an empty stomach first thing in the morning with at least 240 mL (8 oz) of water. After administration, the patient should not have food, drink, medications, or supplements and should remain upright for at least one half-hour (alendronate, risedronate) or one hour (ibandronate).
Δ The 70 mg dose is also available in an effervescent formulation (dissolved over at least 5 minutes in 4 oz of tap water) and an oral solution (follow administration with at least 2 oz of water).
◊ Based on indirect evidence from the alendronate extension trial.
§ The enteric-coated, delayed-release formulation is taken immediately after breakfast with 4 oz of water.

References:

Black DM, Schwartz AV, Ensrud KE, et al. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): A randomized trial. JAMA 2006; 296:2927.
Black DM, Reid IR, Boonen S, et al. The effect of 3 versus 6 years of zoledronic acid treatment of osteoporosis: A randomized extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res 2012; 27:243.

Graphic 131712 Version 2.0

خرید پکیج

Bisphosphonates for the treatment of osteoporosis