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Safety and tolerability of zoledronic acid and other bisphosphonates in osteoporosis management.

Dalle Carbonare L, Zanatta M, Gasparetto A, Valenti MT - Drug Healthc Patient Saf (2010)

Bottom Line: These mechanisms of action are associated with different antifracture efficacy, and NBPs show the most powerful action.Moreover, recent evidence indicates that NBPs can also stimulate osteoblast activity and differentiation.The most recent weekly and monthly formulations, and in particular the yearly infusion of zoledronate, significantly improve persistence with treatment, and optimize clinical, densitometric, and antifracture outcomes.

View Article: PubMed Central - PubMed

Affiliation: Clinic of Internal Medicine D, Department of Medicine, University of Verona, Italy.

ABSTRACT
Bisphosphonates (BPs) are widely used in the treatment of postmenopausal osteoporosis and other metabolic bone diseases. They bind strongly to bone matrix and reduce bone loss through inhibition of osteoclast activity. They are classified as nitrogen- and non-nitrogen-containing bisphosphonates (NBPs and NNBPs, respectively). The former inhibit farnesyl diphosphate synthase while the latter induce the production of toxic analogs of adenosine triphosphate. These mechanisms of action are associated with different antifracture efficacy, and NBPs show the most powerful action. Moreover, recent evidence indicates that NBPs can also stimulate osteoblast activity and differentiation. Several randomized control trials have demonstrated that NBPs significantly improve bone mineral density, suppress bone turnover, and reduce the incidence of both vertebral and nonvertebral fragility fractures. Although they are generally considered safe, some side effects are reported (esophagitis, acute phase reaction, hypocalcemia, uveitis), and compliance with therapy is often inadequate. In particular, gastrointestinal discomfort is frequent with the older daily oral administrations and is responsible for a high proportion of discontinuation. The most recent weekly and monthly formulations, and in particular the yearly infusion of zoledronate, significantly improve persistence with treatment, and optimize clinical, densitometric, and antifracture outcomes.

No MeSH data available.


Related in: MedlinePlus

Effects on bone density and turnover between zoledronate and risedronate in glucocorticoid-induced osteoporosis. Note that zoledronate induces a rapid and higher suppression of resorption markers with respect to risedronate. This can explain the higher increase of bone density with zoledronate in this particular setting.
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f4-dhps-2-121: Effects on bone density and turnover between zoledronate and risedronate in glucocorticoid-induced osteoporosis. Note that zoledronate induces a rapid and higher suppression of resorption markers with respect to risedronate. This can explain the higher increase of bone density with zoledronate in this particular setting.

Mentions: Patients were stratified according to the duration of glucocorticoid treatment prior to their inclusion in the study, ie, less than 3 months (prevention arm) or more than three months (treatment arm). Adequate calcium supplementation of 1000 mg/day was given to all patients, as well as cholecalciferol 400–1000 IU/day. After 1 year of treatment, zoledronate-treated patients showed a significantly greater increase of lumbar spine BMD compared with those on oral risedronate (4.06% versus 2.71%, respectively, P = 0.0001) and of femoral neck BMD (1.45% versus 0.39, respectively, P = 0.005). Similar results were observed in the prevention group. Zoledronic acid showed a faster and more persistent inhibitory effect on bone resorption markers than risedronate (Figure 4). In contrast, the inhibition of bone formation markers was higher in the risedronate-treated group. This effect could represent an advantage in this particular setting, in which the reduction of BMD with an associated increased risk of fracture occurs within a few months after starting glucocorticoid treatment.105


Safety and tolerability of zoledronic acid and other bisphosphonates in osteoporosis management.

Dalle Carbonare L, Zanatta M, Gasparetto A, Valenti MT - Drug Healthc Patient Saf (2010)

Effects on bone density and turnover between zoledronate and risedronate in glucocorticoid-induced osteoporosis. Note that zoledronate induces a rapid and higher suppression of resorption markers with respect to risedronate. This can explain the higher increase of bone density with zoledronate in this particular setting.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3108695&req=5

f4-dhps-2-121: Effects on bone density and turnover between zoledronate and risedronate in glucocorticoid-induced osteoporosis. Note that zoledronate induces a rapid and higher suppression of resorption markers with respect to risedronate. This can explain the higher increase of bone density with zoledronate in this particular setting.
Mentions: Patients were stratified according to the duration of glucocorticoid treatment prior to their inclusion in the study, ie, less than 3 months (prevention arm) or more than three months (treatment arm). Adequate calcium supplementation of 1000 mg/day was given to all patients, as well as cholecalciferol 400–1000 IU/day. After 1 year of treatment, zoledronate-treated patients showed a significantly greater increase of lumbar spine BMD compared with those on oral risedronate (4.06% versus 2.71%, respectively, P = 0.0001) and of femoral neck BMD (1.45% versus 0.39, respectively, P = 0.005). Similar results were observed in the prevention group. Zoledronic acid showed a faster and more persistent inhibitory effect on bone resorption markers than risedronate (Figure 4). In contrast, the inhibition of bone formation markers was higher in the risedronate-treated group. This effect could represent an advantage in this particular setting, in which the reduction of BMD with an associated increased risk of fracture occurs within a few months after starting glucocorticoid treatment.105

Bottom Line: These mechanisms of action are associated with different antifracture efficacy, and NBPs show the most powerful action.Moreover, recent evidence indicates that NBPs can also stimulate osteoblast activity and differentiation.The most recent weekly and monthly formulations, and in particular the yearly infusion of zoledronate, significantly improve persistence with treatment, and optimize clinical, densitometric, and antifracture outcomes.

View Article: PubMed Central - PubMed

Affiliation: Clinic of Internal Medicine D, Department of Medicine, University of Verona, Italy.

ABSTRACT
Bisphosphonates (BPs) are widely used in the treatment of postmenopausal osteoporosis and other metabolic bone diseases. They bind strongly to bone matrix and reduce bone loss through inhibition of osteoclast activity. They are classified as nitrogen- and non-nitrogen-containing bisphosphonates (NBPs and NNBPs, respectively). The former inhibit farnesyl diphosphate synthase while the latter induce the production of toxic analogs of adenosine triphosphate. These mechanisms of action are associated with different antifracture efficacy, and NBPs show the most powerful action. Moreover, recent evidence indicates that NBPs can also stimulate osteoblast activity and differentiation. Several randomized control trials have demonstrated that NBPs significantly improve bone mineral density, suppress bone turnover, and reduce the incidence of both vertebral and nonvertebral fragility fractures. Although they are generally considered safe, some side effects are reported (esophagitis, acute phase reaction, hypocalcemia, uveitis), and compliance with therapy is often inadequate. In particular, gastrointestinal discomfort is frequent with the older daily oral administrations and is responsible for a high proportion of discontinuation. The most recent weekly and monthly formulations, and in particular the yearly infusion of zoledronate, significantly improve persistence with treatment, and optimize clinical, densitometric, and antifracture outcomes.

No MeSH data available.


Related in: MedlinePlus