Several disorders of increased bone turnover and
low bone mineral density (BMD) are associated with severe
pain that is refractory to treatment with conventional and even
opioid analgesics. Because of their ability to effectively improve the underlying pathogenesis of these disorders (i.e., reduce
bone resorption and increase BMD),
bisphosphonates are considered part of the
palliative care of malignant bone-related
pain and also appear to have some
analgesic efficacy in other, non-malignant conditions.
Ibandronate, a potent,
nitrogen-containing
bisphosphonate that can be given orally and intravenously, has demonstrated robust effects in relieving the
pain associated with several malignant disorders. Unlike other available intravenous (i.v.)
bisphosphonates, i.v.
ibandronate is not associated with renal side effects, even at high doses such
as 6 mg every 3 weeks. In addition, oral
ibandronate (50 mg daily) is currently the only oral
bisphosphonate proven to reduce and maintain bone
pain scores below baseline for 2 years in patients with metastatic
bone disease. Lower dose, less intense dosing regimens of
ibandronate relieve bone
pain in non-malignant conditions: i.v.
ibandronate (2 mg every 3 months with or without an initial 4 mg injection) provides
pain relief for patients with
corticosteroid-induced
osteoporosis, localised transient
osteoporosis (bone marrow oedema) and
sternocostoclavicular hyperostosis. Both oral and i.v.
ibandronate are well tolerated. In conclusion,
ibandronate offers an effective and convenient choice for the relief of bone
pain in a wide variety of underlying bone conditions.