Bisphosphonates in osteoporosis

Bisphosphonates (alendronate, zoledronic acid and risedronate)

are analogues of pyrophosphate with a carbon instead of oxygen atom (P-O-P). They attach to the bone crystals and are absorbed by osteoclasts, which breakdown bone. Within the osteoclast, bisphosphonates interfere in the normal function and induce apoptosis. In addition, they decrease the depth of resorption cavities, therefore it slows remodelling rate and decreases resorption at each site of bone turnover. Thus, by inhibiting bone resorption, bisphosphonates freeze the cycle of bone remodelling.

Major side effects of bisphosphonates include GI-complaints since these drugs require administration on an empty stomach.

See also bisphosphonates in oncology and hyperparathyroidism.


In addition to postmenopausal osteoporosis, by which class of patients are bisphosphonates commonly used? 


Which of the following agent antiresorptive agent for postmenopausal osteoporosis can alleviate the back pain associated with vertebral fractures:


Which of the following agents must be ingested on an empty stomach to improve bioavailability: