Table 19.

Route of Administration of the Bisphosphonate Neridronate in PDB

Risk‐benefit balance

Information from randomized trials is only available for the comparison of intravenous and intramuscular modes of administration of neridronate. Both routes of administration were found to give similar results in terms of suppression of ALP and control of bone pain.

Quality of evidence

Low

Patient values and preferences

Improvements in bone pain are valued by patients. Some patients might prefer two infusions as opposed to eight intramuscular injections, although the intramuscular route could be preferred in patients with poor venous access.

Costs and use of resources

Neridronate is inexpensive with little difference between regimens. Nursing support costs may be higher with intramuscular therapy, but day patient facilities and other support costs may be higher with intravenous therapy.

Recommendation

For patients with metabolically active PDB with bone pain treated with neridronate, either the intravenous or intramuscular route can be recommended.