Efficacy and tolerability of cyclical intravenous pamidronate in patients with low bone mass

Oral bisphosphonates are an established mode of therapy for the prevention and treatment of osteoporosis. However, many patients are unable to take them either because of poor tolerability or some established contraindications. This retrospective study describes our clinical experience with the efficacy and tolerability of cyclical intravenous pamidronate in patients with osteopenia or osteoporosis at the American University of Beirut Medical Center. Twenty patients received intravenous pamidronate, as a 30-mg infusion administered intravenously over 2 h every 3 mo. All patients were maintained on calcium and vitamin D supplementation: 1000 mg of calcium and 400-800 IU of vitamin D, respectively. Bone mineral densities of the spine and/or hip were measured at baseline and within an average of 14 mo of study entry while on cyclical pamidronate. Two-thirds of patients had a significant increase in bone mineral density either at the lumbar spine or hip. Five patients (25%) developed the expected acute-phase reaction symptoms. Pamidronate constitutes an attractive alternative therapy in patients who cannot tolerate oral bisphosphonates.