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History of etidronate.
Nelson B Watts1, Charles H Chesnut2, Harry K Genant3
1Mercy Health Osteoporosis and Bone Health Services, 4760 E. Galbraith Rd, Suite 212, Cincinnati, OH 45236, USA.
Bone
|January 9, 2020
Summary
Etidronate, a bisphosphonate, treats bone disorders like Paget's disease and heterotopic ossification. While effective for osteoporosis, its use is limited by potential bone mineralization defects at higher doses.
Area of Science:
- Pharmacology
- Biochemistry
- Bone Metabolism
Background:
- Etidronate is a first-generation, non-nitrogen-containing bisphosphonate known for its calcium-binding properties.
- Initially explored for toothpaste and detergents, its clinical applications evolved to bone-related conditions.
Observation:
- Early use included fibrodysplasia ossificans progressiva, followed by FDA approval for Paget's disease of bone in 1977.
- Approved indications expanded to hypercalcemia of malignancy and heterotopic ossification, with numerous off-label uses.
- Unique among bisphosphonates, oral etidronate can cause hyperphosphatemia and affect vitamin D metabolism.
Findings:
- Therapeutic doses for bone resorption are near those impairing mineralization, potentially causing osteomalacia with prolonged high-dose use.
- Intermittent cyclic therapy improved bone density and reduced vertebral fractures in postmenopausal osteoporosis.
- Similar benefits were observed in men and patients with glucocorticoid-induced osteoporosis.
Implications:
- Despite newer agents, etidronate remains a primary choice for heterotopic ossification due to its specific properties.
- Understanding its dose-dependent effects on mineralization is crucial for safe and effective clinical application.
- Its unique metabolic effects warrant continued investigation in specific bone disease contexts.
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