title: Rational use of oral bisphosphonates for the treatment of osteoporosis.
abstract: Osteoporosis has become a major public health concern worldwide. Significant morbidity, mortality, and health expenditures are associated with osteoporotic fractures. Evidence from randomized controlled trials and meta- analyses supports the efficacy and safety of oral bisphosphonates as first-line pharmacologic agents for the prevention and treatment of osteoporosis. This article reviews the evidence demonstrating the beneficial effects of etidronate, alendronate, and risedronate on improving bone mass and preventing fractures in individuals with or at risk for osteoporosis. Issues surrounding dosing intervals and optimal duration of therapy are also discussed. We conclude that the nitrogen-containing bisphosphonates alendronate and risedronate are safe and efficacious agents in preventing and treating osteoporosis. They are superior to cyclical etidronate in improving appendicular bone mass, and in reducing future risk for nonvertebral fractures. Once-weekly dosing options with alendronate and risedronate are effective and reduce serious adverse drug effects, and therefore, are welcome additions to our therapeutic armamentarium.
authors.affiliation: McMaster University, 201-25 Charlton Ave E., Hamiton, Ontario, L8N 1Y2 Canada.
authors.forename: Julian M R
authors.initials: JM
authors.lastname: Mathoo
authors.forename: Ann
authors.initials: A
authors.lastname: Cranney
authors.forename: Alexandra
authors.initials: A
authors.lastname: Papaioannou
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
mesh_terms: D000284:Administration, Oral; D000368:Aged; D001862:Bone Resorption / Q000517:prevention & control; D002170:Canada; D004164:Diphosphonates / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005598:Fractures, Spontaneous / Q000517:prevention & control*; D006801:Humans; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis / Q000188:drug therapy*; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis / Q000188:drug therapy; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D004164:Diphosphonates