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Commentary
bisphosphonates and calcium homoeostasis
M Pirmohamed
Department
of Pharmacology and Therapeutics, University of Liverpool, Ashton
Street Medical School, Ashton Street, Liverpool L69 3GE, UK
Correspondence to: Dr Pirmohamed (e-mail: munirp@liv.ac.uk)
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Bisphosphonates are synthetic analogues of pyrophosphate (antiscaling agents), and are mainly used in the treatment of hypercalcaemia, Paget's disease of bone, and osteoporosis. The latter is by far their most important indication with latest figures indicating that one in three women and one in 12 men over the age of 50 years will have an osteoporotic fracture.1
Bisphosphonates decrease bone resorption by inhibiting osteoclastic activity. This is accompanied by an increase in calcium balance and in the mineral content of bone. The consequent increase in bone mass is the basis by which these compounds prevent osteoporosis in man. In hypercalcaemia of malignancy, their ability to inhibit bone resorption makes them most effective when osteolytic, rather than humoral, mechanisms are involved.2 Indeed, normalisation of the calcium concentrations is often followed by transient hypocalcaemia; however, this is rarely clinically significant.
What effect do bisphosphonates have on serum calcium concentrations in
normocalcaemic conditions such as
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