Etidronate is used to treat Paget's disease of the bone.

It may also be used to

treat or prevent a certain type of bone problem (heterotopic ossification) after
hip replacement surgery or spinal injury.

Etidronate is also used to treat hypercalcemia (too much calcium in the blood)
that may occur with some types of cancer.

Etidronate is available only with your doctor's prescription.

Generic Name: etidronate

Classification: Bisphosphonates

Prototype of drug: Calcium Regulator

Brands available: Didronel

Dosage For oral dosage form (tablets):

 For Paget's disease of bone:

o Adults—Dose is based on body weight and must be determined by

your doctor. At first, 5 milligrams (mg) per kilogram (kg) (2.3 mg per
pound) of body weight a day, usually as a single dose, for not more
than 6 months. Some people may need 6 to 10 mg per kg (2.7 to 4.6
mg per pound) of body weight a day for not more than 6 months.
Others may need 11 to 20 mg per kg (5 to 9.1 mg per pound) of
body weight a day for not more than 3 months. Your doctor may
adjust your dose depending on your response to treatment.

o Children—Use and dose must be determined by your doctor.

 For treating or preventing a certain type of bone problem that may occur
after hip replacement:

o Adults—Dose is based on body weight and must be determined by

your doctor. The dose is usually 20 milligrams (mg) per kilogram (kg)
(9.1 mg per pound) of body weight a day for 1 month before
surgery, and for 3 months after surgery.

o Children—Use and dose must be determined by your doctor.

  For treating or preventing a certain type of bone problem that may occur
after spinal injury:

o Adults—Dose is based on body weight and must be determined by

your doctor. The dose is usually 20 milligrams (mg) per kilogram (kg)
(9.1 mg per pound) of body weight a day for 2 weeks, beginning as
soon as possible after your injury. Your doctor may then decrease
your dose to 10 mg per kg (4.5 mg per pound) of body weight for an
additional 10 weeks.

o Children—Use and dose must be determined by your doctor.

Pregnancy Category: Pregnancy category C This drug has been shown to

cause skeletal abnormalities in rats when given at oral dose levels 15 to 60 times
the human dose. Other effects on the offspring (including decreased live births)
are at dosages that cause significant toxicity in the parent generation, 25 to 200
times the human dose. There are no data on fetal risk in humans; however, there
is a theoretical risk of fetal harm, predominantly skeletal, if a woman becomes
pregnant after completing a course of bisphosphonate therapy. The impact of
variables such as time between cessation of bisphosphonate therapy to
conception, the particular bisphosphonate used, and the route of administration
(intravenous vs. oral) on this risk has not been studied. There are no controlled
data in human pregnancy.
Mode of Action: Bisphosphonates are taken into the bone where they bind to
hydroxyapatite. Bone resorption by osteoclasts causes local acidification, releasing the
bisphosphonate, which is taken into the osteoclast by fluid-phase
endocytosis.2 Endocytic vesicles become acidified, releasing bisphosphonates into the
cytosol of osteoclasts where they act.2
Osteoclasts mediate resorption of bone. 3 When osteoclasts bind to bone they form
podosomes, ring structures of F-actin.3 Disruption of the podosomes causes osteoclasts
to detach from bones, preventing bone resorption. 3

First generation bisphosphonates closely mimic the structure of pyrophosphate, which

can be incorporated into ATP anologues that cannot be hydrolyzed, disrupting all ATP
mediated actions of osteoclasts

Pharmacokinetics:
Absorption- Poorly absorbed after oral and intravenous administration
Distribution- Widely distributed into the bone
Metabolism- Drug is not metabolized
Excretion- Excreted through feces
Pharmacodynamics:
Etidronic acid is a first generation bisphosphonate that inhibits the action of osteoclasts,
preventing bone resporption.7 It has a wide therapeutic index as overdoses are not associated
with severe toxicity and a long duration of action as it slowly releases from the bone.7 Patients
should be counselled regarding the risk of upper gastrointestinal adverse reactions

Nursing Consideration:

General
Patients should maintain an adequate nutritional status, particularly an adequate
intake of calcium and vitamin D.

Paget’s Disease
In Paget’s patients the response to therapy may be of slow onset and continue for
months after Etidronate disodium therapy is discontinued. Dosage should not be
increased prematurely. A 90-day drug-free interval should be provided between
courses of therapy. Side Effects of Etidronate Sodium
1. Gastric irritation
2. Bone pain
3. Headache
4. Metallic taste
5. Pyrexia
6. Hypersensitivity
7. Nausea
8. Diarrhoea
9. Blood dyscriasis
10. Seizures

What’s Unique with the drug?: Etidronate was the first bisphosphonate to be used in
humans for fibrodysplasia ossificans progressiva and Paget disease.