Ibandronate (ibandronic acid)

(Brand name: Bonviva^®)

Ibandronate is a drug treatment for osteoporosis. It can help to strengthen bones, making them less likely to break. It is available as a monthly tablet, or as an injection every three months.

Ibandronate is a type of medication called a bisphosphonate. Bisphosphonates are the most common treatments for osteoporosis. However, ibandronate isn’t usually given as a first treatment for osteoporosis. It’ll probably only be an option if you’ve already tried one of the more common drug treatments, or if other treatments aren’t suitable for you.

What does ibandronate do and how does it work?

Ibandronate can help to make your bones stronger and reduce your risk of broken bones.

Bones are made up of living tissue. The inside of our bones is constantly being broken down and rebuilt by specialist bone cells. As long as this process is in balance, your bones should stay healthy and strong.

But if the process becomes out of balance, our bodies can start to break down more bone than we build. This can cause the bones to become weaker and more likely to break easily.

Ibandronate works by slowing down the cells that break down bone. This helps to restore the balance and make your bones stronger.

You may still break a bone while taking ibandronate. If this happens, it doesn’t necessarily mean the drug isn’t working. No medication can stop all fractures, but taking ibandronate will make them much less likely.

Ibandronate is not a pain-relieving medicine, so it won’t reduce the pain caused by broken bones. But there are other treatments and ways to manage pain.

Who can have ibandronate?

Ibandronate may be suitable if you have osteoporosis, or if your risk of breaking a bone is high enough to need a drug treatment. It will usually only be an option if you’ve already tried a different drug treatment for your bones, or if other drugs aren’t suitable for you.

It is only licensed for use in women who have been through the menopause. But doctors will sometimes offer ibandronate to men, and occasionally to younger women.

When is ibandronate not suitable?

Ibandronate may not be suitable if you:

• have severe kidney problems
• have a low blood calcium level (hypocalcaemia) – you’ll need to increase your intake of calcium and vitamin D before you can start ibandronate
• are pregnant or breast-feeding
• have a high risk of breaking a hip – because it isn't clear if ibandronate reduces the risk of hip fractures as much as other drugs.

In addition, the tablet form of ibandronate may not be suitable if you:

• can’t swallow tablets
• have a problem with your oesophagus (gullet or food pipe), such as Barrett’s oesophagus
• can’t stand or sit up for at least an hour (see below).

How do I take ibandronate?

Ibandronate is available as either tablets or injections. Both are effective at lowering your risk of breaking a bone.

Tablets

You’ll take one tablet (150mg) each month. This is the most common way to have ibandronate. Make sure you take your tablet regularly and correctly – ideally on the same date each month. It’s a good idea to make a note in your diary or set a reminder on your phone, to help you remember.

The following steps are important for ensuring the treatment works properly. They will also help to make side effects less likely (see below).

Take your tablet as soon as you wake in the morning

It’s very important to take ibandronate on an empty stomach. Swallow the tablet whole, with a glass of plain tap water. Do not crush, chew or suck it. Then wait at least an hour before having your first food or drink of the day (other than plain tap water). This is to make sure your body can absorb and use the drug. If you forget to take your tablet, wait until the next morning before taking it.

Don’t take other medications or supplements during this time

If you take calcium supplements, wait at least an hour after taking ibandronate. This is because calcium can affect how well the drug is absorbed. Some doctors suggest waiting up to four hours, to leave even more time for the drug to be absorbed.

Stay upright for one hour afterwards

You must not lie down for one hour after taking your tablet. This helps the tablet go down quickly into the stomach where it is absorbed. Your food pipe is more likely to become irritated if you lie down straightaway.

Injections

You’ll have an injection every three months, usually at the hospital. It takes about 15-30 seconds to give the injection slowly through a needle into a vein. You can eat and drink as normal on the day of your injection.

How will my treatment be monitored?

When you start on ibandronate, you may have an appointment after around three months, and again after one year. This is to check you’re taking your treatment properly and not having any problems. Tell the doctor, nurse or pharmacist if you have any side effects (see below). They may be able to suggest ways to help manage them.

If you break a bone while having ibandronate, speak to your GP. Breaking a bone doesn’t necessarily mean your treatment isn’t working. But it may be a good idea to have a bone health assessment.

After about five years on ibandronate tablets – or around three years if you’re having injections – you should have a formal treatment review. Ask your doctor when this should happen if you’re unsure. At this review, your doctor will check if you still need a drug treatment, and that ibandronate is still the right treatment for you.

You may have a bone density scan as part of your review, which will give your doctor some information about your bone strength. But they will need to consider other things as well, such as whether you’ve broken any bones since starting on ibandronate.

While there’s no clear way to prove for certain that your treatment is working, research has shown that osteoporosis drug treatments like ibandronate are effective at lowering the risk of broken bones.

Following your review, your doctor may advise you to:

• stay on ibandronate for another 3-5 years
• stop treatment for a year or two, if this is safe for you – this is known as a treatment pause
• start a different drug treatment instead of ibandronate
• stop having any treatment.

Ibandronate is a long-lasting treatment and should keep helping your bones for about 1-2 years after you stop having it. Your doctor can advise you on what’s best for you, based on your own situation.

What are the possible side effects?

As with any drug, ibandronate can sometimes cause side effects. The most common side effects are listed below, along with some rare problems that might very occasionally happen after several years of treatment.

It is important to remember that in general, side effects are less common than many people think. Most people on ibandronate don’t have any problems. Even if you do get side effects at first, they usually improve quickly and there are ways to manage them.

For a full list of possible side effects, look at the patient information leaflet that comes with your treatment. If you don’t have a copy, ask your doctor or pharmacist for one.

It’s important to understand that many of these problems aren’t actually caused by the drug. When a medicine is first tested, the people taking it have to report anything unusual to the researchers. The problems they report are often just as common in people who aren’t taking the drug.

The following table has information on the main side effects that were seen more frequently in people taking ibandronate compared to a dummy drug. For example, fewer than 1 person in every 10 people who have ibandronate tablets will get problems with their oesophagus (food pipe) or heartburn. The other 9 in every 10 people who use the drug will not have this problem.

Rare health risks:

If you do get any side effects that don’t go away, it may help to:

• make sure the problem isn’t caused by any other medication you are taking
• tell your doctor or pharmacist, who may be able to help find out what is causing the problem
• ask your doctor or pharmacist about other treatments that may suit you better.

Making a decision about treatment

As with any treatment, there are advantages and disadvantages to using ibandronate. You should think about these when deciding whether to have ibandronate, and about what’s important to you. Here are some of the main things to consider.

Advantages

• It can help to reduce your risk of broken bones, particularly in your spine.
• If you are prescribed tablets, you’ll only take one a month. This is less than other bisphosphonates, making it more convenient for many people.
• It’s also available as an injection, which is helpful if tablets are a problem for you.
• It starts to work quickly and is effective for at least five years of use.
• It keeps helping your bone strength for a while, even after you stop taking it.

Disadvantages

• As with all medications, some people get side effects.
• There are some possible health risks after several years of use, but these are rare.
• The tablet form won’t be suitable for everyone.
• If your doctor prescribes injections, you’ll need to visit the hospital every three months for these.

If you've thought carefully about the advantages and disadvantages but still feel unsure, we have more information to help guide you through deciding whether or not to have a drug treatment.

Content reviewed: March 2023

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