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Review

Safety and tolerability of zoledronic acid and other bisphosphonates in osteoporosis management

, , &
Pages 121-137 | Published online: 19 Aug 2010

Figures & data

Figure 1 Molecular structure of pyrophosphate and of the most common nitrogen-containing bisphosphonates.

Figure 1 Molecular structure of pyrophosphate and of the most common nitrogen-containing bisphosphonates.

Figure 2 Farnesyl pyrophosphate synthase enzyme inhibition potency (IC50) of nitrogen-containing bisphosphonates (inhibition of 50% of maximum enzyme activity). Note that zoledronic acid shows the higher affinity for the mineral matrix combined with the higher inhibition potency of farnesyl pyrophosphate synthase.Citation26

Abbreviations: ALN, alendronate; IBN, ibandronate; RIS, risendronate; ZOL, zolendronic acid.
Figure 2 Farnesyl pyrophosphate synthase enzyme inhibition potency (IC50) of nitrogen-containing bisphosphonates (inhibition of 50% of maximum enzyme activity). Note that zoledronic acid shows the higher affinity for the mineral matrix combined with the higher inhibition potency of farnesyl pyrophosphate synthase.Citation26

Figure 3 Reduction of new vertebral A) and femoral B) fractures after treatment with several common bisphosphonates.

Figure 3 Reduction of new vertebral A) and femoral B) fractures after treatment with several common bisphosphonates.

Table 1 Bisphosphonates approved for the treatment of osteoporosis

Figure 4 Effects on bone density and turnover between zoledronate and risedronate in glucocorticoid-induced osteoporosis. Note that zoledronate induces a rapid and higher suppression of resorption markers with respect to risedronate. This can explain the higher increase of bone density with zoledronate in this particular setting.

Figure 4 Effects on bone density and turnover between zoledronate and risedronate in glucocorticoid-induced osteoporosis. Note that zoledronate induces a rapid and higher suppression of resorption markers with respect to risedronate. This can explain the higher increase of bone density with zoledronate in this particular setting.