Bisphosphonate (Osteoporosis) Pregnancy: Contraindicated — bisphosphonates incorporated into bone; effective contraception required in women of childbearing potential

Ibandronate

Brand names: Bonviva, Ibandronic Acid

Adult dose

Dose: Oral: 150 mg once monthly; IV: 3 mg every 3 months as bolus over 15–30 seconds

Route: Oral or IV

Frequency: Once monthly (oral); every 3 months (IV)

Max: 150 mg/month (oral); 3 mg/3 months (IV)

Oral: take 30–60 minutes before first food or drink (water only); remain upright for 60 minutes; IV: faster administration than zoledronic acid; no pre-hydration required for 3 mg IV dose per SPC

Paediatric dose

Route: N/A

Frequency: N/A

Max: Not licensed in children

No paediatric indication for osteoporosis

Dose adjustments

Renal

Avoid oral form if eGFR <30 mL/min; IV 3 mg dose: SPC states no adjustment needed if eGFR ≥30

Hepatic

No dose adjustment required

Clinical pearls

Monthly oral compliance advantage: once-monthly regimen significantly improves adherence vs weekly bisphosphonates — BALTO study showed 85% compliance at 1 year vs 60% for weekly; compliance directly correlates with fracture prevention in observational studies
BONE trial evidence: oral ibandronate 2.5 mg daily reduces vertebral fractures by 52%; 150 mg monthly is pharmacokinetically equivalent to 2.5 mg daily; non-vertebral fracture reduction demonstrated in higher-risk subgroups
IV 3 mg quarterly: preferred when oral administration is problematic — oesophageal disease, cognitive impairment, care home setting, post-gastric bypass; faster than zoledronic acid; no annual infusion wait
MHRA 2011 ONJ alert: osteonecrosis of the jaw — risk increases with duration and invasive dental procedures; dental review before starting; avoid invasive dental procedures during treatment; risk much lower with osteoporosis vs oncological doses
Atypical femoral fractures: MHRA 2011 alert — prodromal thigh or groin pain; X-ray or MRI if suspected; consider bisphosphonate holiday after 5 years for lower-risk patients (HORIZON extension data)

Contraindications

eGFR <30 (oral form)
Uncorrected hypocalcaemia
Oesophageal abnormalities (oral form)
Inability to remain upright 60 minutes (oral form)

Side effects

Oesophageal irritation or ulceration (oral if positioning not followed)
Flu-like symptoms (IV first dose)
Hypocalcaemia
Jaw pain (osteonecrosis of jaw)
Atypical femoral fracture (long-term >5 years)
Myalgia

Interactions

Calcium/antacids/iron — chelate bisphosphonate; oral ibandronate must be taken on empty stomach with plain water only
NSAIDs — potential additive GI toxicity (oral)
Aminoglycosides — additive hypocalcaemia risk

Monitoring

Bone density DEXA at 2 years
Calcium and vitamin D before starting
Serum creatinine/eGFR (oral form)
Dental review
Thigh or groin pain surveillance for AFF

Reference: BNFc; BNF 90; NICE TA160/TA464 (Osteoporosis); BONE trial; MHRA Drug Safety Update 2011 (ONJ and AFF); SPC Bonviva. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways