From bathtub ring to osteoporosis: a clinical review of the bisphosphonates.
BACKGROUND
Etidronate and pamidronate are bisphosphonates, a class of chemical compounds originally used to soften hard water and prevent soap scum. Etidronate was serendipitously found to abate calcification in a child with myositis ossificans progressiva.


OBJECTIVE
Review the basic pharmacology of these compounds, as well as clinical uses of the approved and nonapproved forms.


CONCLUSIONS
Etidronate is approved for the treatment of hypercalcemia, Paget's disease of bone, and ectopic calcification, and has been used to treat hyperparathyroidism and nephrolithiasis with limited success. Recently it has been used to treat osteoporosis. Pamidronate is approved to treat hypercalcemia. These two drugs are the only bisphosphonates available in the United States.


CONCLUSIONS
Clinical trials with etidronate have aroused widespread interest in the application of bisphosphonates to treat osteoporosis. Many trials are underway to evaluate these new drugs. More information will be available within the next 5 years.
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Department of Endocrinology, Cleveland Clinic Foundation, OH 44195.
D002128:Calcium Metabolism Disorders / Q000188:drug therapy; D004164:Diphosphonates / Q000494:pharmacology / Q000627:therapeutic use*; D012968:Etidronic Acid / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D006961:Hyperparathyroidism / Q000188:drug therapy; D007669:Kidney Calculi / Q000188:drug therapy; D010001:Osteitis Deformans / Q000188:drug therapy; D010024:Osteoporosis / Q000188:drug therapy*; D000077268:Pamidronate
D004164:Diphosphonates; D012968:Etidronic Acid; D000077268:Pamidronate