REVIEW Alendronic sodium trihydrate is a bisphosphonate drug used for osteoporosis and other bone diseases. It inhibits osteoclast-mediated bone resorption. Unlike pyrophosphate, the endogenous regulator of bone turnover to which it is chemically related, alendronate specifically inhibits osteoclastic osteoclastic bone resorption, having no effect on mineralization of bone newly formed by osteoblasts. The action of alendronate on bone tissue is based partly on its affinity for hydroxyapatite, part of the mineral matrix of bone. Alendronate also targets farnesyl pyrophosphate (FPP) synthase, an enzyme in the mevalonate pathway. Nitrogen-containing bisphosphonates appear to act as analogues of isoprenoid diphosphate lipids, thereby inhibiting FPP synthase in osteoclasts, preventing the biosynthesis of isoprenoid lipids that are essential for the post-translational farnesylation and geranylgeranylation of small GTPase signalling proteins. This activity inhibits osteoclast activity and reduces bone resorption and turnover.
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