Bisphosphonates - How Bisphosphonates Works?

Bisphosphonates Drug - How does Bisphosphonates Works?

Type of Drug:


How the Bisphosphonates Works:

Bisphosphonates help preserve bone mass by inhibiting normal and abnormal bone loss due to resorption (bone tissue loss). Some of these drugs also help control the balance of calcium in bones and blood in certain cancers.

Uses of The Bisphosphonates:

To treat Paget disease of bone (alendronate, etidronate, pamidronate, rise- dronate, tiludronate only).

To treat osteoporosis bone metastases of breast cancer and osteolytic bone losions of multiple myeloma in conjuction with standard antineoplastic thorapy (pamidronate only).

To treat high calcium blood levels in combination with adequate hydration (pamidronate,zoledronic acid only) and bone lesions (pamidronate only) caused by cancer.

To treat osteoporosis in men and postmenopausal women; to prevent osteoporosis in postmenopausal women; to treat glucocorticoid­induced osteoporoses in men and women (alendronate, risedronate only).

To prevent and treat heterotopic ossification (unwanted bone calcification) following total hip replacement or due to spinal cord injury (oral etidronate only).

Unlabeled Uses: To treat osteoporosis in postmenopausal women (etidronate, pamidronate, risedronate only). To prevent osteoporosis in post­menopausal women (risedronate, etidronate only). To treat hyperparathyroidism, high calcium blood levels associated with immobilization; to reduce bone pain in patients with prostatic cancer (pamidronate only). To prevent glucocorticoid-induced osteoporosis (etidronate, pamidronate only).


Do not use in the following situations: allergy to the bisphosphonate or any of its ingredients clinically overt bone softening (osteomalacia) (etidronate only) esophagus abnormalities (alendronate only) inability to stand or sit upright for at least 30 minutes (alendronate, risedronate only)

Use with caution in the following situations: asthma liver disease (zoledronic acid bone fractures only) digestive system disorders low calcium blood levels kidney disease

Pregnancy: There are no adequate or well-controlled studies in pregnant women. Use only if clearly needed and the potential benefits to the mother outweigh the possible hazards to the fetus.

Breastfeeding: It is not known if these drugs appear in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness in children have not been established. Lab tests will be required periodically during treatment. Tests may include blood exams and kidney function tests.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over-­the-counter or prescription medications or dietary supplements with a bisphosphonate. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with bisphosphonates:

Side Effects:

Every drug is capable of producing side effects. Many bisphosphonate users experience no, or minor, side effects. The frequency or severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Digestive Tract: Inflammation of the stomach, nausea; vomiting; diarrhea; constipation; gas; heartburn; indigestion; ulcers; stomach pain; acid regurgitation; difficulty swallowing; bloating; appetite loss; stomach bleeding; taste changes; dental disorder; mouth sores; inflammation of the colon.

Circulatory System: High blood pressure; fainting; rapid heartbeat; irregular heartbeat; anemia; decreased white blood cell and platelet count; abnormal blood tests.

Nervous System: Headache; fatigue; dizziness; drowsiness; weakness; vertigo (feeling of whirling motion); confusion; anxiety; nervousness; sleep disorders; sleeplessness; hallucinations; amnesia; depression; convulsions.

Respiratory System: Difficulty breathing; runny nose; sore throat; sinus infection; coughing; bronchitis; upper respiratory infections.

Skin: Rash; itching; redness, swelling, hardness, or pain at injection site (pamidronate, zoledronic acid only); fungal infections; sweating; flushing; hair loss.

Other: Urinary tract infection; flu-like symptoms; infection; fracture; vitamin D deficiency; fever; general swelling; joint, muscle, chest, neck, leg, back, or bone pain; involuntary muscle contractions; muscle or leg romps; abnormal skin sensations (eg, burning, prickling, tingling); catamcts; glaucoma; eye inflammation.

Guidelines for Use:

  • Pamidronate and zoledronic acid are prepared and administered by your health care provider in a medical setting.
  • Dosage is individualized. Take exactly as prescribed.
  • Do not stop taking or change the dose unless directed by your doctor.
  • If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless advised to do so by your doctor. If more than one dose is missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
  • These medications may cause upset stomach, nausea, or diarrhea.
  • Take supplemental calcium and vitamin 0 as advised by your doctor if dietary intake is inadequate.
  • Avoid nicotine and alcohol, which deplete calcium from the bones.
  • Consider weight-bearing exercises to increase the calcium density of bones.
  • Lab tests will be required to monitor therapy. Be sure to keep appointments.
  • Store tablets at controlled room temperature (59° to 86°F) in a tightly sealed container. Do not remove tiludronate tablets from foil strip until they are to be used ..
  • Alendronate and risedronate _ Take each tablet first thing in morning with a full glass of water (6 to 8 oz) at least 30 minutes before the first food, beverage, or medication of the day. Taking with mineral water, fruit juices, or coffee can decrease its effectiveness. Do not lie down for at least 30 minutes following administration and until after the first food of the day. Discontinue use and notify your physician if you experience new or worsening heartburn or difficult or painful swallowing.


  • Take tablets with a full glass of water (6 to 8 oz) on an empty stomach, at least 2 hours before meals. Take tablets as a single dose. If stomach upset occurs, divide the dose. Do not eat foods (such as milk or dairy products), vitamins, mineral supplements, or antacids that are high in calcium within 2 hours of taking.

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