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Increased bone remodeling reduces bone strength by causing stress risers in thinned trabeculae and increased porosity of cortical bone 2 , and high bone turnover is a risk factor for fracture independent of bone density in elderly subjects 3. Thus, there is a strong rational for the use of pharmacologic agents that reduce osteoclastic bone resorption to treat patients with osteoporosis 4. Bisphosphonates are stable synthetic analogs of pyrophosphate that suppress osteoclast-mediated bone resorption and indirectly decrease osteoblast activity 5. Hence, they should be considered as anti-catabolic drugs in contrast to bone-forming anabolic agents 6.
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