Alendronate sodium (Fosamax®)
Etidronate disodium calcium carbonate (Didrocal®)
Etidronate disodium (Didronel®)
Risedronate sodium hemi-pentahydrate (Actonel®)
Raloxifene (Evista®)

General comments
Tolerability is significantly improved by strict observation of administration instructions. Supplementary calcium (500 to 1,000 mg po/day) and vitamin D (400 to 800 IU po/day) are also required with most products. Must be taken on an empty stomach with water only.

Toxicities associated with bisphosphonates are nausea and vomiting, and oesophagitis.

Indications

• Osteoporosis (treatment and prevention)

Dosage used in clinical practice
10 mg po daily (single dose) or 70 mg po weekly (single dose)

Dosage according to CPS

• Treatment of osteoporosis: 70 mg tablet once a week or one bottle of 70 mg oral solution once a week or 10 mg tablet od
• Prevention of osteoporosis: 5 mg/od

Comments
See manufacturer’s recommendations on administration instructions.

Dosage used in clinical practice
400 mg po (administered 14 consecutive days in 90 day cycles)

• Didrocal® (etidronate disodium-calcium carbonate):
  • 90-day cyclical regimen
  • Each cycle: 400 mg etidronate sodium tablets x 14 days;
    76 blue calcium carbonate tablets od x 76 days
    
• Didronel® (etidronate disodium):
  • 5 mg/kg body weight/day not to exceed six months

Comments
Didrocal® is available in convenient packs which include supplemental calcium on the non-treatment days.

Dosage used in clinical practice
5 mg po/day (single dose) or 35 mg po/week (single dose)

Dosage according to CPS

• 5 mg po/day

Drug
Raloxifene (Evista®)

Dosage used in clinical practice
60 mg po daily (single dose)

Dosage according to CPS

• 60 mg/day

Comments
May exacerbate menopausal symptoms and increase risk of thromboembolic disease.