Bisphosphonates are pyrophosphate analogs (Figure 61-8); they contain 2 phosphonate groups attached to a germinal (central) carbon that replaces the oxygen in pyrophosphate. They have a strong affinity for bone, especially areas undergoing remodeling. They are used extensively in conditions characterized by osteoclast-mediated bone resorption, including osteoporosis, steroid-induced osteoporosis, Paget's disease, tumor-associated osteolysis, breast and prostate cancer, and hypercalcemia.

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