Generic Name: Etidronate Disodium
Class: Bone Resorption Inhibitors
VA Class: HS900
CAS Number: 7414-83-7
Synthetic bisphosphonate; bone resorption inhibitor.c
Uses for Didronel
Paget’s Disease of Bone
Efficacy not established in asymptomatic patients.125 May consider prophylactic treatment in patients with extensive involvement of the skull or spinal column and the possibility of irreversible neurologic damage or in those with extensive involvement threatening major joints or weight-bearing bones.125
Relapse generally tends to occur within about 3–24 months in patients most likely to relapse (e.g., higher pretreatment markers of bone turnover).c
Resistance is most likely to develop in patients receiving >1 course of therapy per year or those with higher pretreatment indices of bone turnover.107
Used in the prevention and treatment of heterotopic ossification (myositis ossificans, ectopic calcification, periarticular ossification, or paraosteoarthropathy) following total hip arthroplasty or resulting from spinal cord injury.125
Bisphosphonates, including etidronate, have been used effectively for the prevention and treatment of corticosteroid-induced osteoporosis†.131 132 133 134 135 136 137 139 141 142 143 144 145 146 The American College of Rheumatology (ACR) currently recommends use of one of several other bisphosphonates (i.e., alendronate, risedronate, or zoledronic acid) in conjunction with lifestyle modification and calcium and vitamin D supplementation for the prevention and treatment of corticosteroid-induced osteoporosis† in select postmenopausal women and men ≥50 years of age who are initiating or currently receiving corticosteroid therapy.166
Didronel Dosage and Administration
Paget’s Disease of Bone
Monitor patients for recurrence of disease every 3–6 months.125 Consider retreatment only after a drug-free interval of ≥90 days following the previous course of therapy if biochemical, symptomatic, or other evidence of recurrence is present.125
Initiate therapy as soon as it is feasible following spinal cord injury and preferably before any radiographic evidence of heterotopic ossification.125 Efficacy of retreatment has not been established in these patients nor in patients undergoing total hip arthroplasty.125
Avoid lying down following oral administration.125
Avoid food, especially calcium-rich food (e.g., milk or milk products), vitamins with mineral supplements, or antacids that contain metals such as calcium, iron, magnesium, or aluminum for 2 hours before and after administration.125 c (See Food under Pharmacokinetics.)
Available as etidronate disodium; dosage expressed in terms of the salt.125
Paget’s Disease of Bone
Onset of therapeutic response may be delayed,125 and therapeutic effects may persist for months following a course of therapy.125 (See Onset under Pharmacokinetics.) Avoid premature increases in dosage125 since increased dosage may cause mineralization defects.125 c
Dosages >20 mg/kg daily not recommended.125
Retreatment: Dosage usually the same as initial treatment.125 Consider increasing dosage within the recommended range if inadequate response with original dosage.125 (See General: Paget’s Disease of Bone under Dosage and Administration.)
Prevention and TreatmentOral
Spinal cord injury: Initially, 20 mg/kg daily for 2 weeks followed by 10 mg/kg daily for an additional 10 weeks (12 weeks total).125
Total hip arthroplasty: Initially, 20 mg/kg daily administered preoperatively for 1 month and postoperatively for an additional 3 months (4 months total).125
Prevention and TreatmentOral
400 mg daily for 2 weeks every 3 months has been used, usually in conjunction with calcium (e.g., 500 mg daily) and vitamin D supplementation during the remaining 10–11 weeks of each cycle or continuously.141 142 143 144 145 146 147
ACR recommends that bisphosphonate therapy be administered for as long as corticosteroid therapy continues.166
Paget’s Disease of Bone
Maximum 20 mg/kg daily.125
Treatment duration: ≤6 months; continuous therapy for >6 months may increase the risk of fracture and osteomalacia.125
Reduce dosage in patients with reduced glomerular filtration; monitor such patients closely.125
Select dosage with caution because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.125
Cautions for Didronel
Esophageal abnormalities that delay esophageal emptying (e.g., stricture, achalasia).125
Known hypersensitivity to etidronate disodium.125
Upper GI Effects
Possible severe adverse esophageal effects (e.g., esophagitis, esophageal ulcers, erosions, strictures, perforation).125 (See Oral Administration under Dosage and Administration.) Monitor for any manifestations and discontinue if dysphagia, odynophagia, new or worsening heartburn, or retrosternal pain occurs.125
Risk of severe adverse esophageal effects greater in patients who do not drink 180–240 mL of water with etidronate, do not avoid lying down for ≥30 minutes following oral administration, and/or continue to take drug after developing symptoms suggesting esophageal irritation.125 Instruct patients carefully about proper administration and give copy of patient instructions provided by the manufacturer.125
Use with caution in patients with history of upper GI disease (e.g., Barrett’s esophagus, dysphagia, other esophageal diseases, gastritis, duodenitis, ulcers).125 Gastric and duodenal ulcers (some severe and with complications) reported during postmarketing experience.125
Maintain an adequate intake of calcium and vitamin D during therapy.125
Therapy has been withheld in some patients with enterocolitis since diarrhea may occur, especially with high dosages.125
Impairs mineralization of new osteoid, principally in pagetic lesions and to a lesser extent in normal bone at dosages of 10–20 mg/kg daily.125 c Also may delay mineralization of ectopic bone.c Mineralization occurs normally following completion of therapy.125
Long bones affected mainly by lytic pagetic lesions, particularly in patients whose disease is unresponsive to therapy, may be especially prone to fractures.125 Monitor patients with predominantly lytic lesions closely, both radiographically and biochemically, to permit timely discontinuance of therapy in those whose disease is unresponsive.125 If fractures occur, may be advisable to delay or withhold therapy until callus is evident.125
Osteonecrosis and osteomyelitis of the jaw reported, principally in cancer patients receiving bisphosphonates, usually when given IV.125 147 148 149 150 151 Associated mostly with dental procedures (e.g., tooth extraction), but some cases occurred in patients with postmenopausal osteoporosis† receiving oral therapy.125 Known risk factors include cancer, chemotherapy, radiation therapy, corticosteroids, poor oral hygiene, preexisting dental disease, anemia, coagulopathy, and infection.125
In patients requiring dental procedures, no data are available to suggest whether discontinuance of therapy prior to procedure reduces the risk of osteonecrosis of the jaw.125 170 Base management of patients requiring dental treatment on an individual assessment of risks and benefits.125 170
Severe and occasionally incapacitating bone, joint, and/or muscle pain reported infrequently with bisphosphonate therapy.125 128 148 153 154 Time to onset varied from 1 day to years (mean onset about 3 months) after treatment initiation.125 128 148 153 154 Such pain generally improves following discontinuance, but may recur upon subsequent rechallenge with the same drug or another bisphosphonate.125 128 148 153 154
Although data are conflicting, possible increased risk of atrial fibrillation with use of bisphosphonates.155 FDA analysis of data from long-term (6 months to 3 years) controlled trials identified a higher rate of atrial fibrillation in patients receiving bisphosphonates (alendronate, ibandronate, risedronate, or zoledronic acid) versus placebo; however, only a few events reported in each study.155 FDA is continuing to monitor this safety concern.155
Potential Risk of Esophageal Cancer
Some evidence (from postmarketing experience and observational studies) suggests a possible association between use of oral bisphosphonates and an increased risk of esophageal cancer.156 160 161 However, because of conflicting data,161 162 163 additional study needed to confirm such findings.160
FDA states that benefits of oral bisphosphonates continue to outweigh their potential risks in patients with osteoporosis; it is important to consider that esophageal cancer is rare, especially in women.160 161
Avoidance of oral bisphosphonates in patients with Barrett’s esophagus, a known precursor to esophageal adenocarcinoma, has been recommended.156
Safety and efficacy in children not established.125 Has been used in children for the prevention of heterotopic ossification or soft tissue calcification at weight-adjusted dosages recommended for adults.125
Rachitic syndrome reported infrequently in children receiving dosages of ≥10 mg/kg daily for approximately 1 year or longer.125 Epiphyseal radiographic changes associated with retarded mineralization of new osteoid and cartilage and associated occasional symptoms were reversible following discontinuance of the drug.125
Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults; select dosage with caution.125 (See Geriatric Patients under Dosage and Administration.)
Possible age-related impaired renal function and risk of toxic reactions; use with care.125 (See Renal Impairment under Cautions and under Dosage and Administration.)
Common Adverse Effects
Paget’s disease of bone: Bone pain, diarrhea, nausea.125
Heterotopic ossification: Diarrhea, nausea.125
Interactions for Didronel
Increases in PT, mostly without clinically important sequelae125
Monitor PT when etidronate added to therapy125
Approximately 3% of a dose is absorbed.125
Paget’s disease of bone: May persist for ≥1 year following discontinuance of therapy.125 In patients whose disease is most likely to relapse, relapse generally tends to occur within about 3–24 months.c
Heterotropic ossification: Persists for ≥9 months following drug discontinuance.125
Food decreases extent of absorption.c
Drug does not cross blood-brain barrier in animals.125
Not known whether etidronate is distributed into milk.125
No evidence of metabolism.125
25°C (may be exposed to 15–30°C).125
Paget’s disease of bone: Reduces the number of osteoclasts and osteoblasts.125
No immunosuppressive activity in animal studies.104
Advice to Patients
Importance of proper administration (e.g., avoiding food, vitamins with mineral supplements, or antacids that contain metals for 2 hours before and after administration).125
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as any concomitant illnesses.125
Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed.125
Importance of informing patients of other important precautionary information.125 (See Cautions.)
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
AHFS DI Essentials. © Copyright, 2016, American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814. Review Date: September 06, 2016.
Only references cited for selected revisions after 1984 are available electronically.
100. MGI Pharma. Didronel I.V. Infusion (etidronate disodium) prescribing information. Minnetonka, MN; 1998 Jan.
101. Norwich Eaton Pharmaceuticals, Inc. Didronel I.V. Infusion (etidronate disodium) background data for review by pharmacy and therapeutic committees. Publication No. 2326-70. Norwich, NY; 1987 Apr.
102. Kanis JA, Urwin GH, Gray RES et al. Effects of intravenous etidronate disodium on skeletal and calcium metabolism. Am J Med. 1987; 82(Suppl 2A):55-70. [IDIS 227717] [PubMed 3103437]
103. Guaitani A, Polentarutti N, Filippeschi S et al. Effects of disodium etidronate in murine tumor models. Eur J Cancer Clin Oncol. 1984; 20:685-93. [PubMed 6428894]
104. Garattini S, Guaitani A, Mantovani A. Effect of etidronate disodium on the interactions between malignancy and bone. Am J Med. 1987; 82(Suppl 2A):29-33. [IDIS 227713] [PubMed 3103435]
105. Jacobs TP, Gordon AC, Silverberg SJ et al. Neoplastic hypercalcemia: physiologic response to intravenous etidronate disodium. Am J Med. 1987; 82(Suppl 2A):42-50. [IDIS 227715] [PubMed 3030098]
106. Powell JH, DeMark BR. Clinical pharmacokinetics of diphosphonates. In: Garattini S, ed. Bone resorption, metastasis, and diphosphonates. New York: Raven Press; 1985:41-9.
107. Altman RD. Long-term follow-up of therapy with intermittent etidronate disodium in Paget’s disease of bone. Am J Med. 1985; 79:583-90. [IDIS 207333] [PubMed 3933343]
108. Perry HM III, Droke DM, Avioli LV. Alternate calcitonin and etidronate disodium therapy for Paget’s bone disease. Arch Intern Med. 1984; 144:929-33. [IDIS 184749] [PubMed 6424594]
109. Charhon S, Chapuy MC, Valentin-Opran A et al. Intravenous etidronate for spinal cord dysfunction due to Paget’s disease. Lancet. 1982; 1:391-2. [IDIS 144906] [PubMed 6120363]
110. Meunier PJ, Chapuy MC, Delmas P et al. Intravenous disodium etidronate therapy in Paget’s disease of bone and hypercalcemia of malignancy: effects on biochemical parameters and bone histomorphometry. Am J Med. 1987; 82(Suppl 2A):71-8. [IDIS 227718] [PubMed 3103438]
111. Ryzen E, Martodam RR, Troxell M et al. Intravenous etidronate in the management of malignant hypercalcemia. Arch Intern Med. 1985; 145:449-52. [IDIS 197140] [PubMed 3919667]
112. Hasling C, Charles P, Mosekilde L. Etidronate disodium for treating hypercalcaemia of malignancy: a double blind, placebo-controlled study. Eur J Clin Invest. 1986; 16:433-7. [PubMed 3100312]
113. Zweig JI, Shafer N. Treatment of hypercalcemia with etidronate disodium. JAMA. 1980; 244:437-8. [IDIS 125509] [PubMed 6771418]
114. Mundy GR, Wilkinson R, Heath DA. Comparative study of available medical therapy for hypercalcemia of malignancy. Am J Med. 1983; 74:421-32. [IDIS 168018] [PubMed 6219578]
115. Ringenberg QS, Ritch PS. Efficacy of oral administration of etidronate disodium in maintaining normal serum calcium levels in previously hypercalcemic cancer patients. Clin Ther. 1987; 9:318-25. [PubMed 3111705]
116. Schiller JH, Rasmussen P, Benson AB III et al. Maintenance etidronate in the prevention of malignancy-associated hypercalcemia. Arch Intern Med. 1987; 147:963-6. [IDIS 229062] [PubMed 3107487]
117. Hagg E, Eklund M, Torring O. Disodium etidronate in hypercalcaemia due to immobilisation. BMJ. 1984; 288:607-8. [IDIS 182308] [PubMed 6421398]
118. Merli GJ, McElwain GE, Adler AG et al. Immobilization hypercalcemia in acute spinal cord injury treated with etidronate. Arch Intern Med. 1984; 144:1286-8. [IDIS 186433] [PubMed 6428341]
119. Meythaler JM, Korkor AB, Nanda T et al. Immobilization hypercalcemia associated with Landry-Guillain-Barré syndrome: successful therapy with combined calcitonin and etidronate. Arch Intern Med. 1986; 146:1567-71. [IDIS 219423] [PubMed 3089187]
120. Anon. Medical management of primary hyperparathyroidism. Lancet. 1984; 2:727-8. [PubMed 6148476]
121. Licata AA, O’Hanlon E. Treatment of hyperparathyroidism with etidronate disodium. JAMA. 1983; 249:2063-4. [PubMed 6403720]
122. Scher HI, Yagoda A. Bone metastases: pathogenesis, treatment, and rationale for use of resorption inhibitors. Am J Med. 1987; 82(Suppl 2A):6-28. [IDIS 227712] [PubMed 3548343]
123. Bounameux HM, Schifferli J, Montani JP et al. Renal failure associated with intravenous diphosphonates. Lancet. 1983; 1:471. [IDIS 166642] [PubMed 6131186]
124. Boyce BF, Fogelman I, Ralston S et al. Focal osteomalacia due to low-dose diphosphonate therapy in Paget’s disease. Lancet. 1984; 1:821-4. [IDIS 184178] [PubMed 6143140]
125. Procter & Gamble Pharmaceuticals. Didronel (etidronate disodium) tablets prescribing information. Cincinnati, OH; 2011 Jan.
126. Francis MD, Slough CL. Acute intravenous infusion of disodium dihydrogen (1-hydroxyethylidene)diphosphonate: mechanism of toxicity. J Pharm Sci. 1984; 73:1097-1100. [PubMed 6436463]
127. Food and Drug Administration. Orphan designations pursuant to Section 526 of the Federal Food and Cosmetic Act as amended by the Orphan Drug Act (P.L. 97-414), to June 28, 1996. Rockville, MD; 1996 Jul.
128. Procter & Gamble Pharmaceuticals. Actonel(risedronate sodium) tablets prescribing information. Cincinnati, OH; 2000 Apr.
129. Miller PD, Brown JP, Siris ES et al. A randomized, double-blind comparison of risedronate and etidronate in the treatment of Paget’s disease of bone. Am J Med. 1999; 106:513-20. [IDIS 428270] [PubMed 10335722]
130. Plotkin LI, Weinstein RS, Parfitt AM et al. Prevention of osteocyte and osteoblast apoptosis by bisphosphonates and calcitonin. J Clin Invest. 1999; 104:1363-74. [PubMed 10562298]
131. Adachi JD, Bensen WG, Brown J et al. Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis. N Engl J Med. 1997; 337:382-7. [IDIS 389180] [PubMed 9241127]
132. Roux C, Oriente P, Laan R et al. Randomized trial of the effect of cyclical etidronate in the prevention of corticosteroid-induced bone loss. J Clin Endocrinol Metab. 1998; 83:1128-33. [IDIS 404610] [PubMed 9543129]
133. Adachi JD, Saag KG, Delmas PD et al. Two-year effects of alendronate on bone mineral density and vertebral fracture in patients receiving glucocorticoids: a randomized, double-blind, placebo-controlled extension trial. Arthritis Rheum. 2001; 44:202-11. [PubMed 11212161]
134. Reid DM, Hughes RA, Laan RF et al. Efficacy and safety of daily risedronate in the treatment of corticosteroid-induced osteoporosis in men and women: a randomized trial. J Bone Miner Res. 2000; 15:1006-20. [PubMed 10841169]
135. Diamond T, McGuigan L, Barbagallo S et al. Cyclical etidronate plus ergocalciferol prevents glucocorticoid-induced bone loss in postmenopausal women. Am J Med. 1995; 98:459-63. [IDIS 348269] [PubMed 7733124]
136. Cohen S, Levy RM, Keller M et al. Risedronate therapy prevents corticosteroid-induced bone loss: a twelve-month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum. 1999; 42:2309-18. [IDIS 438381] [PubMed 10555025]
137. Wallach S, Cohen S, Reid DM et al. Effects of risedronate treatment on bone density and vertebral fracture in patients on corticosteroid therapy. Calcif Tissue Int. 2000; 67:277-85. [PubMed 11000340]
138. American College of Rheumatology Task Force on Osteoporosis Guidelines. Recommendations for the prevention and treatment of gluococorticoid-induced osteoporosis. Arthritis Rheum. 1996; 39:1791-801. [IDIS 375200] [PubMed 8912500]
139. American College of Rheumatology Ad Hoc Committee on Glucocorticoid-induced Osteoporosis. Recommendations for the prevention and treatment of gluococorticoid-induced osteoporosis: 2001 update. Arthritis Rheum. 2001; 44:1496-503. [IDIS 466759] [PubMed 11465699]
140. Sambrook PN. Corticosteroid osteoporosis: practical implications of recent trials. J Bone Miner Res. 2000; 15:1645-9. [PubMed 10976984]
141. Jenkins EA, Walker-Bone KE, Wood A et al. The prevention of corticosteroid-induced bone loss with intermittent cyclical etidronate. Scand J Rheumatol. 1999; 28:152-6. [PubMed 10380836]
142. Hanley DA, Ioannidis G, Adachi JD. Etridronate therapy in the treatment and prevention of osteoporosis. J Clin Densitom. 2000; 3:79-95. [PubMed 10745305]
143. Sebaldt RJ, Ioannidis G, Adachi JD et al. 36 month intermittent cyclical etidronate treatment in patients with established corticosteroid induced osteoporosis. J Rheumatol. 1999; 26:1545-9. [IDIS 429220] [PubMed 10405943]
144. Cortet B, Hachulla E, Barton I et al. Evaluation of the efficacy of etidronate therapy in preventing glucocorticoid-induced bone loss in patients with inflammatory rheumatic diseases. A randomized study. Rev Rhum Engl Ed. 1999; 66:214-9. [PubMed 10339777]
145. Pitt P, Li F, Todd P et al. A double blind placebo controlled study to determine the effects of intermittent cyclical etidronate on bone mineral density in patients on long-term oral corticosteroid treatment. Thorax. 1998; 53:351-6. [IDIS 410649] [PubMed 9708225]
146. Struys A, Snelder AA, Mulder H. Cyclical etidronate reverses bone loss of the spine and proximal femur in patients with established corticosteroid-induced osteoporosis. Am J Med. 1995; 99:235-42. [IDIS 353366] [PubMed 7653482]
147. Ruggiero SL, Mehrotra B, Rosenberg TJ et al. Osteonecrosis of the jaw associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg. 2004; 62:527-34. [IDIS 518769] [PubMed 15122554]
148. Novartis. Zometa (zoledronic acid) injection prescribing information. East Hanover, NJ; 2004 Aug.
149. Hohneker JA. Dear doctor letter regarding osteonecrosis of the jaw in patients with cancer receiving bisphophonates. East Hanover, NJ: Novartis; 2004 September 24.
150. Ruggiero SL, Mehrotra B. Ten years of alendronate treatment for osteoporosis in postmenopausal women. N Engl J Med. 2004; 351:191.
151. Bone HG, Santora AC. Ten years of alendronate treatment for osteoporosis in postmenopausal women. N Engl J Med. 2004; 351:191-2.
152. Food and Drug Administration. Center for Drug Evaluation and Research. Dugs@FDA:Didronel. Available at . Accessed 2005 Jan 4.
153. Center for Drug Evaluation and Research, Food and Drug Administration. FDA Alert: Information on bisphosphonates (marketed as Actonel, Actonel+Ca, Aredia, Boniva, Didronel, Fosamax, Fosamax+D, Reclast, Skelid, and Zometa). 2008 Jan 7. From FDA website. Accessed 2008 Oct 28.
154. Wysowski DK, Chang JT. Alendronate and risedronate: reports of severe bone, joint, and muscle pain. Arch Intern Med. 2005; 165:346-7. [PubMed 15710802]
155. Center for Drug Evaluation and Research, Food and Drug Administration. Update of safety review follow-up to the October 1, 2007 early communication about the ongoing safety review of bisphosphonates. Bisphosphonates: alendronate (Fosamax, Fosamax plus D) etidronate (Didronel), ibandronate (Boniva), Pamidronate (Aredia), risedronate (Actonel, Actonel w/calcium), tiludronate (Skelid), and zoledronic acid (Reclast, Zometa). 2008 Nov 12. From FDA website. Accessed 2008 Nov 21.
156. Wysowski DK. Reports of esophageal cancer with oral bisphosphonate use. N Engl J Med. 2009; 360:89-90. Letter. [PubMed 19118315]
157. Food and Drug Administration. FDA Drug Safety Communication: Safety update for osteoporosis drugs, bisphosphonates, and atypical fractures. Silver Spring, MD; 2010 Oct 13. From FDA website. Accessed 2010 Nov 4.
158. Shane E, Burr D, Ebeling PR et al. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2010; 25:2267-94. [PubMed 20842676]
159. Food and Drug Administration. FDA News Release: Possible increased risk of thigh bone fracture with bisphosphonates. Silver Spring, MD; 2010 Oct 13. From FDA website. Accessed 2010 Nov 4.
160. Food and Drug Administration. FDA drug safety communication: Ongoing safety review of oral osteoporosis drugs (bisphosphonates) and potential increased risk of esophageal cancer. Rockville, MD; 2011 July 21. Available from FDA website. Accessed 2011 Sept 12.
161. Green J, Czanner G, Reeves G et al. Oral bisphosphonates and risk of cancer of oesophagus, stomach, and colorectum: case-control analysis within a UK primary care cohort. BMJ. 2010; 341:c4444. [PubMed 20813820]
162. Cardwell CR, Abnet CC, Cantwell MM et al. Exposure to oral bisphosphonates and risk of esophageal cancer. JAMA. 2010; 304:657-63. [PubMed 20699457]
163. Abrahamsen B, Eiken P, Eastell R. More on reports of esophageal cancer with oral bisphosphonate use. N Engl J Med. 2009; 360:1789; author reply 1791-2.
164. Abrahamsen B, et al. The risk of oesophageal and cancer incidence and mortality in alendronate users: a national cohort study. Presented at the 3rd Joint Meeting of the European Calcified Tissue Society and the International Bone and Mineral Society. Athens, Greece: May 10, 2011. Abstract No. 0C29.
165. Solomon DH, Patrick A, Brookhart MA. More on reports of esophageal cancer with oral bisphosphonate use. N Engl J Med. 2009; 360:1789-90; author reply 1791-2. [PubMed 19391255]
166. Grossman JM, Gordon R, Ranganath VK et al. American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res (Hoboken). 2010; 62:1515-26. [PubMed 20662044]
167. Kanis JA, Oden A, Johansson H et al. FRAX and its applications to clinical practice. Bone. 2009; 44:734-43. [PubMed 19195497]
168. North American Menopause Society. Management of osteoporosis in postmenopausal women: 2010 position statement of the North American Menopause Society. Menopause. 2010; 17:25-54. [PubMed 20061894]
170. Merck. Fosamax (alendronate sodium) tablets and oral solution prescribing information. Whitehouse Station, NJ; 2006 Dec.
171. Sato Y, Kanoko T, Yasuda H et al. Beneficial effect of etidronate therapy in immobilized hip fracture patients. Am J Phys Med Rehabil. 2004; 83:298-303. [PubMed 15024332]
172. American College of Obstetricians and Gynecologists. Osteoporosis. Washington, DC; 2004 Jan. ACOG practice bulletin No. 50.
173. Kasting GB, Francis MD. Retention of etidronate in human, dog, and rat. J Bone Miner Res. 1992; 7:513-22. [PubMed 1615760]
174. Migliorati CA, Casiglia J, Epstein J et al. Managing the care of patients with bisphosphonate-associated osteonecrosis: an American Academy of Oral Medicine position paper. J Am Dent Assoc. 2005; 136:1656-68.
175. Food and Drug Administration. FDA MedWatch label change: Atypical fractures update for bisphosphonates (osteoporosis drugs), including alendronate (marketed as Fosamax), alendronate with cholecalciferol (marketed as Fosamax plus D), risedronate (marketed as Actonel and Atelvia), risedronate with calcium carbonate (marketed as Actonel with Calcium), ibandronate (marketed as Boniva), and zoledronic acid (marketed as Reclast). Silver Spring, MD; 2010 Oct 13. From FDA web site. Accessed 2010 Nov 4.
176. Giusti A, Hamdy NA, Papapoulos SE. Atypical fractures of the femur and bisphosphonate therapy: A systematic review of case/case series studies. Bone. 2010; 47:169-80. [PubMed 20493982]
177. Girgis CM, Sher D, Seibel MJ. Atypical femoral fractures and bisphosphonate use. N Engl J Med. 2010; 362:1848-9. [PubMed 20463351]
178. Schmidt GA, Horner KE, McDanel DL et al. Risks and benefits of long-term bisphosphonate therapy. Am J Health Syst Pharm. 2010; 67:994-1001. [PubMed 20516469]
c. AHFS drug information 2007. McEvoy GK, ed. Etidronate. Bethesda, MD: American Society of Health-System Pharmacists; 2007:3703-7.