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Novel formulations of oral bisphosphonates in the treatment of osteoporosis

Novel formulations of oral bisphosphonates in the treatment of osteoporosis
Novel formulations of oral bisphosphonates in the treatment of osteoporosis
Oral bisphosphonates are a key intervention in the treatment of osteoporosis and in reducing the risk of fragility fractures. Their use is supported by over 3 decades of evidence; however, patient adherence to oral bisphosphonates remains poor in part due to complex dosing instructions and adverse events, including upper gastrointestinal symptoms. This problem has led to the development of novel oral bisphosphonate formulations. Buffered, effervescent alendronate is dissolved in water and so seeks to reduce upper gastro-intestinal adverse events, and gastro-resistant risedronate aims to reduce the complexity of dosing procedure (e.g. fasting prior to consumption) whilst still maintaining the efficacy of fracture risk reduction. Clinical trials and real-world data have been employed to demonstrate some benefits in terms of reduced upper gastro-intestinal adverse events, adherence, persistence and health economic outcomes. This report describes the result of an ESCEO (European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis) expert working group, which explores where oral bisphosphonates sit in current clinical practice guidelines, review their risk-benefit profile and the consequences of poor adherence before exploring novel oral bisphosphonate formulations and their potential clinical and health economic impact. Further research is required but there are signs that these novel, oral bisphosphonate formulations may lead to improved tolerance of oral bisphosphonates and thus, improved adherence and fracture outcomes.
Alendronate, Bisphosphonates, Fragility fracture, Osteoporosis, Risedronate, Therapy
1594-0667
2625-2634
Fuggle, Nicholas
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Al-Daghri, Nasser
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Bock, Olivier
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Branco, Jaime
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Bruyère, Olivier
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Casado, Enrique
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Cavalier, Etienne
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Cortet, Bernard
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de Wit, Maarten
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Giusti, Andrea
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Halbout, Philippe
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Harvey, Nicholas C
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Hiligsmann, Mickaël
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Kaufman, Jean-Marc
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Kurth, Andreas
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Maggi, Stefania
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Matijevic, Radmila
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Minisola, Salvatore
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Palacios, Santiago
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Radermecker, Régis Pierre
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Thomasius, Friederike
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Tuzun, Sansin
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Veronese, Nicola
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Kanis, John A
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Reginster, Jean-Yves
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Rizzoli, René
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Cooper, Cyrus
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Fuggle, Nicholas
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Al-Daghri, Nasser
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Bock, Olivier
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Branco, Jaime
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Bruyère, Olivier
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Casado, Enrique
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Cavalier, Etienne
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Cortet, Bernard
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de Wit, Maarten
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Giusti, Andrea
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Halbout, Philippe
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Harvey, Nicholas C
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Hiligsmann, Mickaël
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Kaufman, Jean-Marc
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Kurth, Andreas
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Maggi, Stefania
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Matijevic, Radmila
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Minisola, Salvatore
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Palacios, Santiago
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Radermecker, Régis Pierre
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Thomasius, Friederike
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Tuzun, Sansin
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Veronese, Nicola
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Kanis, John A
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Reginster, Jean-Yves
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Rizzoli, René
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Cooper, Cyrus
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Fuggle, Nicholas, Al-Daghri, Nasser, Bock, Olivier, Branco, Jaime, Bruyère, Olivier, Casado, Enrique, Cavalier, Etienne, Cortet, Bernard, de Wit, Maarten, Giusti, Andrea, Halbout, Philippe, Harvey, Nicholas C, Hiligsmann, Mickaël, Kaufman, Jean-Marc, Kurth, Andreas, Maggi, Stefania, Matijevic, Radmila, Minisola, Salvatore, Palacios, Santiago, Radermecker, Régis Pierre, Thomasius, Friederike, Tuzun, Sansin, Veronese, Nicola, Kanis, John A, Reginster, Jean-Yves, Rizzoli, René and Cooper, Cyrus (2022) Novel formulations of oral bisphosphonates in the treatment of osteoporosis. Aging Clinical and Experimental Research, 34 (11), 2625-2634. (doi:10.1007/s40520-022-02272-z).

Record type: Review

Abstract

Oral bisphosphonates are a key intervention in the treatment of osteoporosis and in reducing the risk of fragility fractures. Their use is supported by over 3 decades of evidence; however, patient adherence to oral bisphosphonates remains poor in part due to complex dosing instructions and adverse events, including upper gastrointestinal symptoms. This problem has led to the development of novel oral bisphosphonate formulations. Buffered, effervescent alendronate is dissolved in water and so seeks to reduce upper gastro-intestinal adverse events, and gastro-resistant risedronate aims to reduce the complexity of dosing procedure (e.g. fasting prior to consumption) whilst still maintaining the efficacy of fracture risk reduction. Clinical trials and real-world data have been employed to demonstrate some benefits in terms of reduced upper gastro-intestinal adverse events, adherence, persistence and health economic outcomes. This report describes the result of an ESCEO (European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis) expert working group, which explores where oral bisphosphonates sit in current clinical practice guidelines, review their risk-benefit profile and the consequences of poor adherence before exploring novel oral bisphosphonate formulations and their potential clinical and health economic impact. Further research is required but there are signs that these novel, oral bisphosphonate formulations may lead to improved tolerance of oral bisphosphonates and thus, improved adherence and fracture outcomes.

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s40520-022-02272-z - Version of Record
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Accepted/In Press date: 3 October 2022
Published date: 4 November 2022
Additional Information: Funding Information: The ESCEO Working Group was funded by the ESCEO. The ESCEO receives unrestricted educational grants to support its educational and scientific activities from non-governmental organizations, not-for-profit organizations, non-commercial or corporate partners. Publisher Copyright: © 2022, The Author(s).
Keywords: Alendronate, Bisphosphonates, Fragility fracture, Osteoporosis, Risedronate, Therapy

Identifiers

Local EPrints ID: 472361
URI: http://eprints.soton.ac.uk/id/eprint/472361
ISSN: 1594-0667
PURE UUID: c4f20728-0675-4efd-a0a1-b040f1b002ff
ORCID for Nicholas Fuggle: ORCID iD orcid.org/0000-0001-5463-2255
ORCID for Nicholas C Harvey: ORCID iD orcid.org/0000-0002-8194-2512
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 02 Dec 2022 17:38
Last modified: 18 Mar 2024 03:49

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Contributors

Author: Nicholas Fuggle ORCID iD
Author: Nasser Al-Daghri
Author: Olivier Bock
Author: Jaime Branco
Author: Olivier Bruyère
Author: Enrique Casado
Author: Etienne Cavalier
Author: Bernard Cortet
Author: Maarten de Wit
Author: Andrea Giusti
Author: Philippe Halbout
Author: Mickaël Hiligsmann
Author: Jean-Marc Kaufman
Author: Andreas Kurth
Author: Stefania Maggi
Author: Radmila Matijevic
Author: Salvatore Minisola
Author: Santiago Palacios
Author: Régis Pierre Radermecker
Author: Friederike Thomasius
Author: Sansin Tuzun
Author: Nicola Veronese
Author: John A Kanis
Author: Jean-Yves Reginster
Author: René Rizzoli
Author: Cyrus Cooper ORCID iD

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