Talk:Bisphosphonate

---

This article mentions that bisphosphonate is synonymous with diphosphonate. I'm not a pharmacologist, but aren't these distinct classes of molecules (biochemically-speaking)? I'm thinking of the difference between bisphosphate and diphosphate — bis refers to phosphates separately bound to a parent group, while di refers to a chain of phosphates linked to the parent group. I'd suspect that the same terminology applies here as well. Of course, maybe I just can't recall enough college biochem ;-) --Diberri | Talk 23:19, May 20, 2004 (UTC)

Diphosphate definition

Diphosphate: An ester of phosphoric acid containing two phosphate groups.

Source: The American Heritage® Dictionary of the English Language, Fourth Edition Copyright © 2000 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved. http://dictionary.reference.com/search?r=66&q=diphosphate

{{sofixit}} JFW | T@lk 07:23, 12 August 2005 (UTC)

Bisphosphonate is the chemically correct name for the drug. They were originally designed as analogues of pyrophosphate and incorrectly named disphosphonate. The disphosphonate name is historical, but I think it is useful that it is cited here. Dr Aaron 23:41, 9 July 2006 (UTC)

---

The side effects section of this page requires a citation. The listed frequencies for the osteonecrosis of the jaw side-effect are contradicted in this article at NYTimes.com ( http://www.nytimes.com/2006/06/02/health/02jaw.html?hp&ex=1149307200&en=add01a0366c2bcf3&ei=5094&partner=homepage).

This article states that reliable data on the frequency of the noted side-effect are non-existent. As such the list frequency (80% for some situations) may be a misleading and cause undue panic about these drugs. The frequency cited in this article is 1-10% for cancer patients, because they recieve higher doses (likely by IV), and this data is considered uncertain (as indicated by such a large range). 63.251.131.90 13:31, 2 June 2006 (UTC) --Mercutio.Wilder 13:34, 2 June 2006 (UTC)

ONJ (osteonecrosis of the jaw) is a relatively new phenomenon. Based on discussion at the "What's New in Bisphosphonates" conference in Davos Switzerland (2006), it was generally agreed that it is a real effect, although there is debate on how common it is. As far as I'm aware, virtually all the cases of bisphosphonate-induced ONJ are associated with dental extractions in cancer patients. Dr Aaron 23:41, 9 July 2006 (UTC)

We need to be vary careful how we present this. Dr Zak (talk · contribs) has tried to link osteonecrosis of the jaw to osteonecrosis or to phossy jaw. Both are related but different conditions, and I suspect we need a new article to document this phenomenon. Phossy jaw is (by definition) caused by white phosphorus, and osteonecrosis of other bones has not been linked to bisphonates. The evidence is quite incontrovertible; if there is a view that states that cancer patients have abnormal bone metabolism (especially in myeloma) we should cover this too. JFW | T@lk 10:37, 26 July 2006 (UTC)

I have deleted and "has an excellent safety record." I have not researched the connection with osteonecrosis, but the drugs do cause ulcers, which are a serious health condition. The citation given for this assertion requires a $130 subscription to NEJM, so I can't check what the author, Elizabeth Shane, says about safety. It's certainly not in the first couple of paragraphs. Furthermore, you CAN see her disclosure forms and her research is funded by the makers of bisphonates, so she is hardly a disinterested source of information. Eperotao (talk) 16:56, 2 January 2011 (UTC)

An extra 5 years of life an unexpected benefit of osteoporosis treatment

Journal of Clinical Endocrinology and Metabolism Abstract: http://jcem.endojournals.org/cgi/content/abstract/jc.2010-2730v1 Press release: http://www.eurekalert.org/pub_releases/2011-02/ra-ae5020111.php —Preceding unsigned comment added by 203.206.162.148 (talk) 07:47, 12 April 2011 (UTC)

MOA section is poor

"Bisphosphonates' mechanisms of action all stem from their structures' similarity to pyrophosphate (see figure above). A bisphosphonate group mimics pyrophosphate's structure, thereby inhibiting activation of enzymes that utilize pyrophosphate." This MOA explanation is poor. Could someone beef up this section with a more detailed MOA for bisphosphonates? --159.178.231.56 (talk) 12:47, 27 January 2012 (UTC)

Location of FPPS in mevolonate pathway (compared to statin inhibition)?

Where is FPPS located in the mevolonate pathway? I was wondering where N-bisphosphonate-based FPPS inhibition lies in comparison to statin-based HMG-CoA — Preceding unsigned comment added by Jimw338 (talk • contribs) 15:25, 9 April 2012 (UTC)

Removal of femoral fragility fractures

This diff reverted my summary of the conclusions of this review of Biphosphonate-induced femoral fragility fractures. The conclusions of a peer reviewed, review article that is the most recent available do not fall under WP:NOTHOWTO. WP:YOU was cited, but there is no speaking in the 2nd person.

This reason given though: "there is an association, but the benefits with regards to other fractures outweigh the small absolute risk of femoral shaft fractures" is WP:OR. You cannot censor reliable information because you believe it contradicts what you believe. Please read the paper and address your complaints to whether or not I have provided an accurate summary of the material, and not whether the material is correct or not. Whoever wrote this article has, in a misguided attempt to promote the positive effects of BPs, censored meaningful and relevant information. It is clear from the facts present that the benefits far outweigh the fragility fractures, what is surprising is that by the tone of this article it appears as though someone is arguing otherwise. This article seems to try and defend BPs, but I am unaware of anyone criticizing BPs, they do not need defending, so please stop trying to defend them here, they have already proven themselves and you are making it sound like a controversial drug.AerobicFox (talk) 04:02, 26 April 2012 (UTC)

It wasn't so much the reference but the fact that you wrote "clinicians should be aware", which is an odd thing for an encyclopedia to say. In addition to this, the complication is already mentioned so there is none of that promotion that you accuse me of. I have removed the "clinicians should be aware" thing, because it adds nothing, but have retained the option of teriparatide. JFW | T@lk 08:06, 29 April 2012 (UTC)

A big error in this article leading patients to distrust doctors' prescriptions of bisophosponates

This error reminds me of the error in the folinic acid article that claims the prescribing folic acid for methotrexate rescue therapy is a medical error.

I'm not an MD and I'm not a pharmacist, so I'm not going to make the change because I don't feel I'm qualified. But from publicly accessible information it appears to me, a patient with an electrical engineering background, that this article is clearly in error.

On bisphosophonates: "Evidence shows that they reduce the risk of osteoporotic fracture in those who have had previous fractures. However, they do not reduce fracture risk in those with osteoporosis who have not previously had a fracture.[1][2]"

In fact footnote [1] contradicts what this article says: "In women who have already been diagnosed with low bone density putting them at risk for fracture or have already had a fracture in the bones of their spine, risedronate: - probably prevents fractures in the bones of the spine and in bones other than in the spine; - may prevent hip fractures; - may not lead to any difference in wrist fractures." http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004523.pub3/abstract?systemMessage=Wiley+Online+Library+will+be+disrupted+on+9+June+from+10%3A00-12%3A00+BST+%2805%3A00-07%3A00+EDT%29+for+essential+maintenance

Footnote [2] also says that bisphosophonates work and says nothing about needing to have had previous fractures. Footnote [2] says they work and explores alternative theories about how they work.

"Heretofore, the discrepancy between the antifracture efficacy of bisphosphonates and the absence of any effect on the number of osteoclasts has been attributed to the imprecision of histomorphometric indexes of bone resorption.11 Indeed, osteoclasts in normal persons occupy less than 1% of the cancellous perimeter, so that a decrease in their number might be difficult to detect.13 Alternative explanations for this discrepancy include a greater effect of the drugs on cortical than on cancellous bone, a bisphosphonate-induced decrease in the rate of bone resorption by osteoclasts, and nonadherence to long-term drug therapy.1" http://www.nejm.org/doi/full/10.1056/NEJMoa0802633#t=articleDiscussion 50.71.203.92 (talk) 01:34, 7 June 2012 (UTC)

Medical Letter 2014

Good review of osteoporosis drugs including bisphosphonates:
https://secure.medicalletter.org/TML-article-1452a
Drugs for Postmenopausal Osteoporosis
The Medical Letter on Drugs and Therapeutics. 56(1452):91-96. September 29, 2014

Abramowicz M
http://medicalletter.wordpress.com/2014/09/11/osteoporosis-a-big-problem/
Osteoporosis: A Big Problem
More@MedLetter. September 11, 2014

--Nbauman (talk) 12:19, 6 July 2015 (UTC)

risk of oral cancer

Hello, I removed this primary content:

The risk of oesophageal cancer increases with 10 or more prescriptions for oral bisphosphonates over a five-year period. In Europe and North America, the incidence of oesophageal cancer at age 60-79 is typically 1 per 1000 population over five years, and this is estimated to increase to about 2 per 1000 with five years' use of oral bisphosphonates.
Further down the article it says: "Three meta analyses have evaluated whether bisphosphonate use is associated with an increased risk of esophageal cancer. Two studies concluded that there was no evidence of increased risk.[34][35][36]"

Thanks,JenOttawa (talk) 00:53, 21 March 2018 (UTC)

References