Endocrine Abstracts

Bisphosphonates, because of their efficacy, safety and ease of administration, are accepted as first-line therapy for osteoporosis worldwide. They decrease the rate of bone resorption but have also distinct pharmacological properties including preferential uptake in the skeleton, primarily at sites with increased bone remodeling, and long-term retention in bone. There are differences among bisphosphonates both in their affinity for bone as well as in their antiresorptive potencies and the whole molecule is responsible for their inhibitory effect of bone resorption. Available potent bisphosphonates can be given to patients by different dosing schedules that range from daily oral administration to yearly intravenous infusions. While at the bone surface bisphosphonates decrease the rate of bone resorption and turnover, maintain or improve structural and material properties of bone, increase areal mineral density and thereby decrease the risk of fractures. Bisphosphonates are generally safe provided that recommendations and indications for their use are followed. Selection of a bisphosphonate for the treatment of an individual patient should be based on review of efficacy data, risk profile of the bisphosphonate and values and preferences of the patient. However, despite progress in our understanding of the basic and clinical pharmacology of bisphosphonates there are still controversial issues in the use of bisphosphonates in the management of osteoporosis that remain to be addressed. The most important of these issues is the length of treatment and, consequently, its potential role in the development of the rare, but serious clinical events of osteonecrosis of the jaw and atypical fractures of the femur. In addition, potential, clinically relevant differences among individual bisphosphonates, optimal selection of patients for treatment, use in combination with bone forming agents as well as their action in reducing all-cause mortality in treated patients need to be clarified.

Declaration of interest: The author declares that there is a conflict of interest.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.