Table 18. Route of administration of the bisphosphonate neridronate in PDB.

Risk-benefit balance Information from randomised 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 8 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 differences 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.