Ibandronate: new options in the treatment of osteoporosis

Bisphosphonates are currently considered the treatment of choice for corticosteroid-induced male osteoporosis and represent one of the options for the prevention and treatment of postmenopausal osteoporosis. The treatment of osteoporosis with antiresorbing agents requires long-lasting or even lifelong therapies. Oral bisphosphonates are reasonably well tolerated, but a sizable proportion of patients report esophageal symptoms which are occasionally severe. In addition, their intestinal absorption is only 0.5-1% and the presence of any residual food in the stomach completely blocks absorption. Intravenous bisphosphonate administration, which avoids the upper gastrointestinal tolerability concerns associated with oral regimens, may be of considerable value for many patients such as elderly and institutionalized patients because it ensures full treatment compliance, but the intravenous route has to be used with caution since acute renal failure has been observed following the intravenous administration of several bisphosphonates and prolonged intravenous infusions can also be potentially associated with thrombotic complications and infections. Bisphosphonate dosing by intravenous injection could provide a convenient alternative to intravenous infusion that would be suitable for use in the primary care setting and would avoid many of the complications associated with prolonged infusions. This option is viable with the highly potent, nitrogen-containing bisphosphonates such as ibandronate, which, unlike other lower potency bisphosphonates, can be administered as an intravenous injection of only a few milligrams in regimens with extended between-dose intervals. In this review, the data obtained with ibandronate, using both oral administration and intravenous injection, for the treatment and prevention of postmenopausal osteoporosis are summarized.