Ibandronic acid

How it works

It binds avidly to bone mineral and inhibits osteoclast-mediated bone resorption, reducing bone turnover and fracture risk.

Prescribing in practice

• Oral doses must be taken on an empty stomach with plain water while sitting or standing upright and remaining so afterwards, to reduce the risk of oesophageal irritation and ulceration.
• Correct hypocalcaemia and ensure adequate calcium and vitamin D before starting, and assess dental health given the risk of osteonecrosis of the jaw.
• Use is restricted in significant renal impairment; review against current prescribing references.

Monitoring

Monitor renal function and serum calcium, and reinforce dental review for osteonecrosis-of-the-jaw risk during treatment.

Counselling the patient

• Follow the dosing instructions exactly: take with water on an empty stomach and stay upright, not lying down, afterwards.
• Maintain good oral hygiene and report any dental pain, jaw swelling or new thigh or groin pain.
• Report difficulty or pain on swallowing or new heartburn promptly.

Evidence & guidelines

Bisphosphonates reduce fracture risk in osteoporosis and are recommended within NICE and MHRA-informed prescribing guidance, including warnings on jaw osteonecrosis and atypical femoral fractures.