A review of bone pain relief with ibandronate and other bisphosphonates in disorders of increased bone turnover

• Published in: Clinical and experimental rheumatology Vol. 25; no. 5; pp. 766 - 774
• Main Authors: RINGE, J. D, BODY, J.-J
• Format: Journal Article
• Language: English
• Published: Pisa Clinical and Experimental Rheumatology 01.09.2007
• Subjects: Biological and medical sciences; Bone and Bones - metabolism; Bone Density; Bone Density Conservation Agents - therapeutic use; Bone Diseases, Metabolic - complications; Bone Diseases, Metabolic - drug therapy; Bone Diseases, Metabolic - metabolism; Bone Neoplasms - complications; Bone Neoplasms - drug therapy; Bone Neoplasms - metabolism; Bones, joints and connective tissue. Antiinflammatory agents; Diphosphonates - therapeutic use; Diseases of the osteoarticular system; Fundamental and applied biological sciences. Psychology; Humans; Medical sciences; Osteoporosis. Osteomalacia. Paget disease; Pain - drug therapy; Pain - etiology; Pharmacology. Drug treatments; Skeleton and joints; Vertebrates: osteoarticular system, musculoskeletal system; Antiosteoporotic; Diseases of the osteoarticular system; Antiresorptive agent; Diphosphonic acid derivatives; Ibandronic acid; Bone disease; Review; Bone remodeling; Bone diseases; Bisphosphonates; Pain; Antiosteoclastic agent; Bone; pain relief; Bibliographic review; ibandronate
• ISSN: 0392-856X; 1593-098X

Several disorders of increased bone turnover and low bone mineral density (BMD) are associated with severe pain that is refractory to treatment with conventional and even opioid analgesics. Because of their ability to effectively improve the underlying pathogenesis of these disorders (i.e., reduce bone resorption and increase BMD), bisphosphonates are considered part of the palliative care of malignant bone-related pain and also appear to have some analgesic efficacy in other, non-malignant conditions. Ibandronate, a potent, nitrogen-containing bisphosphonate that can be given orally and intravenously, has demonstrated robust effects in relieving the pain associated with several malignant disorders. Unlike other available intravenous (i.v.) bisphosphonates, i.v. ibandronate is not associated with renal side effects, even at high doses such as 6 mg every 3 weeks. In addition, oral ibandronate (50 mg daily) is currently the only oral bisphosphonate proven to reduce and maintain bone pain scores below baseline for 2 years in patients with metastatic bone disease. Lower dose, less intense dosing regimens of ibandronate relieve bone pain in non-malignant conditions: i.v. ibandronate (2 mg every 3 months with or without an initial 4 mg injection) provides pain relief for patients with corticosteroid-induced osteoporosis, localised transient osteoporosis (bone marrow oedema) and sternocostoclavicular hyperostosis. Both oral and i.v. ibandronate are well tolerated. In conclusion, ibandronate offers an effective and convenient choice for the relief of bone pain in a wide variety of underlying bone conditions.