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Non-nitrogen containing compounds

Etidronate (Didronel)

Clodronate

Tiludronate

Nitrogen-containing compounds

Pamidronate  (Aredia)

Alendronate  (Fosamax)

Risedronate  (Actonel)

Zoledronate  (Zometa)

Ibandronate  (Boniva)

Mechanism of action: Antiresorptive

Complications: Serious esophageal events

Prescription:  

Must be taken on an empty stomach

Overnight fast

With 8 oz of water by mouth

For at least 30 minutes remain upright (seated or standing)

Bisphosphonates and Reports of Bone, Joint and/or Muscle Pain. U.S. Food and Drug Administration. FDA Alert: Information for Healthcare Professionals: Bisphosphonates (marketed as Actonel, Actonel+Ca, Aredia, Boniva, Didronel, Fosamax, Fosamax+D, Reclast, Skelid, and Zometa). January 7, 2008

• Rare
• Bone, joint and/or muscle pain (sometimes very severe)
• Occurring within days, months, or even years
• Bisphosphonates (Fosamax®, Actonel®, Boniva®, and Reclast®)
• In nearly all reported cases, pain is relieved when the bisphosphonate therapy stopped.
• Should not to be confused with the many other aches and pains
• Most osteoporosis specialists have seen no more than one or two cases despite clinical use of this class of drugs for more than 15 years.
• NOF believes the benefits of bisphosphonate treatment in patients at risk of osteoporotic fracture strongly outweigh the risks from treatment.

Osteonecrosis of the Jaw (ONJ)

• Usually lower jaw becomes exposed, typically after a dental extraction or some other trauma to the jaw,
• Wound that occurs fails to heal in the usual time frame.
• Infection in the area can occur and the area may be painful.
• Can become a chronic problem

Bisphosphonates