Pamidronate

Pamidronate is a nitrogen-containing bisphosphonate derivative. Pamidronate selectively binds to hydroxyapatite on the bone surface, particularly at sites of active bone resorption. When osteoclasts resorb bone, pamidronate is taken up into the cells along with the bone matrix. Within osteoclasts, pamidronate inhibits farnesyl pyrophosphate synthase, blocking the formation of intermediate products required for prenylation. When small GTP-binding proteins such as Ras, Rho, and Rab cannot undergo prenylation, multiple osteoclast metabolic processes are suppressed, ultimately leading to osteoclast apoptosis.