Bisphosphonates are used clinically for the treatment of osteoporosis, osteitis deformans (Paget's disease of the bone), bone metastasis (with or without hypercalcaemia), multiple myeloma, and other conditions that feature bone fragility.
In osteoporosis and Paget's, alendronate and risedronate are the most popular first-line drugs. If these are ineffective or the patient develops digestive tract problems, intravenous pamidronate may be used. As an alternative, strontium ranelate or teriparatide is used for refractory disease, and the SERM raloxifene is occasionally administered in postmenopausal women instead of bisphosphonates.
High-potency intravenous bisphosphonates have shown to modify progression of skeletal metastasis in several forms of cancer, especially breast cancer. I
n a randomized control trial, women with breast cancer that received zoledronic acid had a 36% reduction of risk for a recurrence of their breast cancer, a new cancer in the opposite breast, or metastasis to bone compared to women that did not receive that therapy.
Other bisphosphonates, medronate and oxidronate are mixed with radioactive technetium and are injected for imaging bone and detecting bone disease.
Bisphosphonates are used on the International Space station by crew members on long-duration missions.
More recently, bisphosphonates have been used to reduce fracture rates in children with osteogenesis imperfecta and in treatment of otosclerosis.
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