Alendronate, ibandronate, risedronate, zoledronate

Pyrophosphate analogs. Bind hydroxyapatite in bone, inhibiting osteoclast activity.Osteoclasts that reabsorb the bone take up the bisphosphanate and are unable to adhere to the bony surface to continue absorption. - Also decrease osteoclast proton production, induce osteoclast apoptosis decrease development of osteoclast precursor cells.

Clinical use:- Osteoporosis- Hypercalcemia- Paget's disease of the bone- Metastatic bone disease- Osteogenesis imperfecta

Adverse effects:- Esophagitis (patients are advised to take with water and remain upright for 30 minutes)- Osteonecrosis of the jaw- Atypical femoral stress fractures