Current Concepts Review   |    
Bisphosphonates in Orthopaedic Surgery
Carol D. Morris, MD, MS1; Thomas A. Einhorn, MD2
1 Orthopaedic Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Suite A-342, New York, NY 10021. E-mail address: morrisc@mskcc.org
2 Department of Orthopaedic Surgery, Boston University Medical Center, 720 Harrison Avenue, Boston, MA 02116
View Disclosures and Other Information
Investigation performed at Memorial Sloan-Kettering Cancer Center, New York, NY, and Boston University Medical Center, Boston, Massachusetts

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Jul 01;87(7):1609-1618. doi: 10.2106/JBJS.D.03032
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Bisphosphonates are the most clinically important class of antiresorptive agents available to treat diseases characterized by osteoclast-mediated bone resorption.

Currently, seven bisphosphonates have the approval of the United States Food and Drug Administration.

The most common adult diseases treated with bisphosphonates include osteoporosis, Paget disease, and metastatic bone disease.

The treatment of pediatric disorders such as osteogenesis imperfecta and fibrous dysplasia with bisphosphonates has gained momentum, and initial investigations have demonstrated an acceptable safety profile.

Currently, there is a lack of long-term follow-up data, which will be necessary for the development of responsible guidelines for therapy.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    John J Carey
    Posted on August 04, 2005
    re: FDA approved Bisphosphonates
    The Cleveland Clinic Foundation

    To the Editor:

    We congratulate Drs. Morris and Einhorn on their excellent review(1). However, we feel clarification is necessary on two issues mentioned in their article.

    1. Although etidronate was the first available oral bisphosphonate in the U.S.A. and Europe, and is sometimes used to treat osteoporosis, it was never approved by the F.D.A. for this reason; in fact the application was denied. It is approved for the treatment of symptomatic Paget's disease of bone and heterotopic ossification(2,3). The only F.D.A. approved bisphosphonates for the treatment and prevention of osteoporosis are Ibandronate, Risedronate and alendronate.

    2. Bisphosphonates are not the only medications shown to reduce the risk of hip fracture in large randomized trials; both conjugated equine estrogen(4) and strontium ranelate(5) have also been shown to reduce this risk, though the latter results were published only recently and strontium ranelate is currently not available in the U.S.A.


    1. Morris CD, Einhorn TA. Bisphosphonates in Orthopaedic Surgery. J Bone Joint Surg Am. 2005 Jul;87(7):1609-18.

    2. Didronel Package Insert available at: http://www.pgpharma.com/pi/US-Didronel.pdf

    3. Physician’s Desk Reference 2005; 59th Edition. Thomson PDR, New Jersey: 2805-6.

    4. Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, Black H, Bonds D, Brunner R, Brzyski R, Caan B, Chlebowski R, Curb D, Gass M, Hays J, Heiss G, Hendrix S, Howard BV, Hsia J, Hubbell A, Jackson R, Johnson KC, Judd H, Kotchen JM, Kuller L, LaCroix AZ, Lane D, Langer RD, Lasser N, Lewis CE, Manson J, Margolis K, Ockene J, O'Sullivan MJ, Phillips L, Prentice RL, Ritenbaugh C, Robbins J, Rossouw JE, Sarto G, Stefanick ML, Van Horn L, Wactawski-Wende J, Wallace R, Wassertheil-Smoller S; Women's Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA. 2004 Apr 14;291(14):1701-12.

    5. Reginster JY, Seeman E, De Vernejoul MC, Adami S, Compston J, Phenekos C, Devogelaer JP, Curiel MD, Sawicki A, Goemaere S, Sorensen OH, Felsenberg D, Meunier PJ. Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) study.J Clin Endocrinol Metab. 2005 May;90(5):2816-22.

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