Ibandronate

Ibandronate is a nitrogen-containing bisphosphonate used to treat and prevent osteoporosis in postmenopausal women and to reduce the risk of vertebral fractures associated with osteoporosis. It binds to bone surfaces and inhibits osteoclast-mediated bone resorption, helping to maintain or increase bone mineral density.

The mechanism involves inhibition of the mevalonate pathway in osteoclasts, specifically by blocking farnesyl pyrophosphate synthase. This disrupts osteoclast function and promotes osteoclast apoptosis, leading to reduced bone turnover and stronger bone structure over time.

Ibandronate is available in two main forms: oral tablets and intravenous infusion. The oral regimen is typically 2.5 mg once daily or 150 mg once a month. The intravenous form is generally 3 mg given every three months. When taking the oral tablet, it should be swallowed with a full glass of water at least 30 to 60 minutes before the first food, beverage, or medication of the day, and the patient should remain upright for at least 60 minutes to reduce the risk of esophageal irritation. Calcium, antacids, or iron supplements should be taken at a different time from the medication.

Common adverse effects include gastrointestinal symptoms such as abdominal pain, heartburn, and nausea. Serious but rare risks include osteonecrosis of the jaw and atypical femoral fractures, as well as hypocalcemia. Adequate calcium and vitamin D intake is important, and patients should be monitored for hypocalcemia and renal function. Ibandronate is marketed under brand names such as Boniva in some regions.