Background: Bisphosphonates (BPs) are the main options in medical treatment of osteoporosis. They decrease the bone resorption and bone formation. Currently alendronate (ALN), ibandronate (IBN), risedronate (RIS) and zoledronate (ZOL) are approved for the treatment of osteoporosis. It raises concerns about the dimension of decrease of bone remodelling. Therefore, we have investigated bone markers in treatment with diverse BPs in daily routine.
Methods: A retrospective monocentric study including 99 BP-naive female patients suffering postmenopausal osteoporosis was performed. The patients received either oral ALN or RIS and iv. IBN or ZOL. Measurements of bone specific alkaline phosphatase (BAP), tartrate resistant acid phosphatase (TRAP5b), calcium and phosphorus were performed at baseline and after 3 months of treatment. Bone density was measured using QCT before and after 3 years of treatment.
Results: Bone density was not significantly different using oral or i.v. BPs (differences in % from baseline oral:4,33±11,31 vs. i.v.: 7,66±14,25). Considering the bone markers the only difference was found between IBN and ZOL for the BAP (p< 0,02) [Table 1].
|Number of patients (n)||22||24||25||28|
|TRAP(5b) (U/l): reduction in %:||-7,91±36,04||-2,31±29,53||-7,25±26,91||-6,15±41,99|
|BAP (μg/l): reduction in %||-14,58±22,77||-8,11±31,65||-25,08±22,13||-3,55±0,0|
Conclusion: In general, all BPs supressed bone remodelling. The most impressive effect was found for IBN with a very high reduction of bone formation. ALN was seen to supress bone resorption as intensive as ZOL. The small number of patients examined might be the reason for the lack of significance. It remains to be investigated whether these differences cause different long term effects of the BPs. Should these results of daily routine taken into consideration which BP we should choose?
Disclosure: The authors declared no competing interests.