Bisphosphonates in bone diseases

Bisphosphonates are a class of drugs which are strongly attracted to the bo ne where they influence the calcium metabolism, mainly by inhibition of the osteoclast-mediated bone resorption. This property makes these compounds s uited for the treatment of several diseases of the bone. In Paget's disease , several bisphosphonates can reduce bone pain and decrease the bone turnov er 60-70%. Cyclical oral etidronate and daily oral alendronate both proved to reduce the vertebral fracture rate for bisphosphonates can increase spin al bone mass in osteoporosis. Bisphosphonates can help lowering serum calci um and reverse skeletal complications in malignancy mediated bone diseases. Oral and intravenous administration of therapeutic doses is relatively saf e. In general, gastrointestinal disturbances are described most often and t he oldest, least potent, bisphosphonate etidronate can induce osteomalacia. The various characteristics of bisphosphonates: physicochemical, biologica l, therapeutic and toxicological, vary greatly depending on the structure o f the individual bisphosphonate. Even small changes in the structure can le ad to enormous differences in potency. Overall, this class of drugs offers several prospects for the future.