From bathtub ring to osteoporosis: a clinical review of the bisphosphonates
Donald G. Vidt, MD
Alan Bakst, PharmD
Angelo A. Licata, MD, PhDAddress reprint requests to A.A.L., Department of Endocrinology, A80, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
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.DISCUSSION
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.