Once-monthly oral ibandronate in postmenopausal osteoporosis: translation and updated review

As a result of the reported efficacy of oral Bisphosphonates in reducing fractures, increasing bone mineral density (BMD), and reducing bone turnover, these agents are the recommended first line of treatment of postmenopausal osteoporosis. However, in clinical practice, patients might not be diagnosed or prescribed appropriate treatment. Even when bisphosphonates are prescribed, their therapeutic benefit may be compromised by poor treatment compliance and/or failure to persist with the treatment prescribed. New drugs or treatment regimens that reduce the risk for osteoporotic fractures and make the treatment of osteoporosis more convenient and suitable for patients are needed.

The aims of the present review were to discuss the efficacy of monthly ibandronate in the treatment of postmenopausal osteoporosis and to determine treatment adherence with this drug.

A search of MEDLINE (key terms: ibandronate and ibandronic acid; publication dates: 1996-December 2008) was used to identify studies of the efficacy and adherence of ibandronate in the treatment of postmenopausal osteoporosis. Additional searches were conducted to identify publications pertinent to compliance using the terms bisphosphonate and compliance.

A total of 15 articles were included in the present review. An analysis of data from 2 US data-bases reported that once-monthly ibandronate was associated with significantly improved treatment persistence relative to weekly bisphosphonates at 1 year. In BONE (Oral Ibandronate Osteoporosis Vertebral Fracture Trial in North America and Europe), the risk for new vertebral fractures was reduced by 62% with oral ibandronate 2.5 mg/d versus placebo (P < 0.001) at 3 years. In the 2-year MOBILE (Monthly Oral Ibandronate in Ladies) study, oral ibandronate 150 mg once monthly was associated with significantly increased lumbar spine BMD (P < 0.001), and bone turnover markers were numerically decreased compared with the daily regimen. A meta-analysis reported a 38% lower risk for nonvertebral fractures with combined high doses of ibandronate (including oral iban-dronate 150 mg monthly and ibandronate 3 mg IV every 3 months) compared with oral ibandronate 2.5 mg/d (change in annual cumulative exposure, from > or =10.8 to 5.5 mg).

Based on the findings from the studies included in the present review, treatment with oral ibandronate 150 mg once monthly was reported to be at least as effective as the daily regimen and was associated with increased adherence. Monthly iban-dronate might provide an option for the treatment of postmenopausal osteoporosis.