Intermittent Cyclic Tiludronate in the Treatment of Osteoporosis

Reginster, Jean‐Yves; Christiansen, Claus; Roux, Christian; Fechtenbaum, J.; Rouillon, A.; Tou, Kevin

doi:10.1007/s001980170126

Cited by 37 publications

(13 citation statements)

References 30 publications

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“…However, a meta‐analysis of studies with cyclical etidronate showed an overall significant reduction in the risk of vertebral but not of nonvertebral fractures 50 . Oral tiludronate given at two different doses for 1 week every month did not significantly reduce the risk of osteoporotic fractures 51 . Nitrogen‐containing bisphosphonates have also been given intermittently, usually with drug‐free intervals of 3 months.…”

Section: Antifracture Efficacy Of Bisphosphonatesmentioning

confidence: 99%

Use of bisphosphonates in the management of postmenopausal osteoporosis

Papapoulos

2010

Annals of the New York Academy of Sciences

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Bisphosphonates are widely used in the treatment of postmenopausal osteoporosis. They decrease the rate of bone turnover, maintain or improve structural and material properties of bone, and increase bone mineral density and thereby decrease the risk of fractures. Available potent bisphosphonates can be given to patients by different dosing regimens that range from daily oral administration to yearly intravenous infusions. Controlled studies, extending to 10 years of continuous treatment, provide information about long-term efficacy and safety and can help in the planning of long-term treatment strategies. Selection of bisphosphonates for the treatment of individuals should be based on a careful review of efficacy data, a risk profile of the bisphosphonate, and values and preferences of the patient.

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Section: Antifracture Efficacy Of Bisphosphonatesmentioning

confidence: 99%

Use of bisphosphonates in the management of postmenopausal osteoporosis

Papapoulos

2010

Annals of the New York Academy of Sciences

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“…Oral tiludronate given at two different doses for 1 week every month did not significantly reduce the risk of osteoporotic fractures. 30 Nitrogen-containing bisphosphonates have also been given intermittently, usually with drug-free intervals of 3 months. [45][46][47][48][49][50][51] However, in no such study was fracture incidence assessed.…”

Section: Bisphosphonate Dosing At Extended Drug-free Intervalsmentioning

confidence: 99%

“…[26][27][28] However, earlier attempts to administer bisphosphonates at drug-free intervals of longer than 1 week were mostly unsuccessful in significantly reducing the risk of fractures in patients with osteoporosis. [29][30][31] To gain insight into the mechanism of fracture reduction by bisphosphonates given with extended drug-free intervals, determinants of bisphosphonate action in relation to the bone remodelling cycle need to be considered. In this paper we explore these relationships using data from clinical studies with ibandronate, a nitrogencontaining bisphosphonate that has been given at different doses and variable time intervals to patients with postmenopausal osteoporosis.…”

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confidence: 99%

Changes in bone remodelling and antifracture efficacy of intermittent bisphosphonate therapy: implications from clinical studies with ibandronate

Papapoulos

Schimmer²

2008

Postgraduate Medical Journal

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Bisphosphonates reduce the rate of bone resorption and bone remodelling. Given daily, they decrease the risk of fractures in postmenopausal osteoporosis. When bisphosphonates were given at extended drug-free intervals this antifracture efficacy was generally not seen. This may be due to the different pattern of bone remodelling changes. Data from randomised clinical studies of ibandronate, given orally or intravenously, at different doses and for variable time intervals to women with osteoporosis were examined to explore the relationship between intermittent bisphosphonate therapy, changes in bone resorption and fracture risk. The magnitude of the reduction of the rate of bone resorption at the end of the drug-free interval rather than its fluctuation pattern after bisphosphonate administration determines antifracture efficacy, provided that these fluctuations occur within the premenopausal range. Prolongation of the drug-free interval beyond 2 weeks should be compensated by a dose higher than the cumulative daily dose.

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“…Six publications were excluded because they reported on total number of fractures and the number of patients with at least one fracture was not published and could not be derived from published data [34, 46,73,76,80,85]. Sixteen publications were excluded because the duration of observation was less than 36 months [5,7,15 [61] had a median duration of only 21 months, but was kept in the final analysis as it was stopped early by the sponsor.…”

Section: Resultsmentioning

confidence: 99%

Medical treatment of vertebral osteoporosis

Lippuner

The Aging Spine

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Although osteoporosis is a systemic disease, vertebral fractures due to spinal bone loss are a frequent, sometimes early and often neglected complication of the disease, generally associated with considerable disability and pain. As osteoporotic vertebral fractures are an important predictor of future fracture risk, including at the hip, medical management is targeted at reducing fracture risk. A literature search for randomized, double-blind, prospective, controlled clinical studies addressing medical treatment possibilities of vertebral fractures in postmenopausal Caucasian women was performed on the leading medical databases. For each publication, the number of patients with at least one new vertebral fracture and the number of randomized patients by treatment arm was retrieved. The relative risk (RR) and the number needed to treat (NNT, i.e. the number of patients to be treated to avoid one radiological vertebral fracture over the duration of the study), together with the respective 95% confidence intervals (95%CI) were calculated for each study. Treatment of steroid-induced osteoporosis and treatment of osteoporosis in men were reviewed separately, based on the low number of publications available. Forty-five publications matched with the search criteria, allowing for analysis of 15 different substances tested regarding their anti-fracture efficacy at the vertebral level. Bisphosphonates, mainly alendronate and risedronate, were reported to have consistently reduced the risk of a vertebral fracture over up to 50 months of treatment in four (alendronate) and two (risedronate) publications. Raloxifene reduced vertebral fracture risk in one study over 36 months, which was confirmed by 48 months' follow-up data. Parathormone (PTH) showed a drastic reduction in vertebral fracture risk in early studies, while calcitonin may also be a treatment option to reduce fracture risk. For other substances published data are conflicting (calcitriol, fluoride) or insufficient to conclude about efficacy (calcium, clodronate, etidronate, hormone replacement therapy, pamidronate, strontium, tiludronate, vitamin D). The low NNTs for the leading substances (ranges: 15-64 for alendronate, 8-26 for risedronate, 23 for calcitonin and 28-31 for raloxifene) confirm that effective and efficient drug interventions for treatment and prevention of osteoporotic vertebral fractures are available. Bisphosphonates have demonstrated similar efficacy in treatment and prevention of steroid-induced and male osteoporosis as in postmenopausal osteoporosis. The selection of the appropriate drug for treatment of vertebral osteoporosis from among a bisphosphonate (alendronate or risedronate), PTH, calcitonin or raloxifene will mainly depend on the effi-REVIEW Eur Spine J (2003) 12 (Suppl. 2) : S132-S141

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Intermittent Cyclic Tiludronate in the Treatment of Osteoporosis

Cited by 37 publications

References 30 publications

Use of bisphosphonates in the management of postmenopausal osteoporosis

Use of bisphosphonates in the management of postmenopausal osteoporosis

Changes in bone remodelling and antifracture efficacy of intermittent bisphosphonate therapy: implications from clinical studies with ibandronate

Medical treatment of vertebral osteoporosis

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