( 12 ) United States Patent

US010016446B2 (12 ) United States Patent ( 10) Patent No. : US 10 ,016 ,446 B2 Tabuteau ( 45 ) Date of Patent: * Jul. 10 , 2018 (54 ) COMPOSITIONS FOR ORAL (58 ) Field of Classification Search ADMINISTRATION OF ZOLEDRONIC ACID CPC .. . . . A61K 31/ 675 ; A61K 31/ 56 ; A61K 9 /0053 OR RELATED COMPOUNDS FOR See application file for complete search history . TREATING PAGET ' S DISEASE OF BONE (56 ) References Cited (71 ) Applicant : ANTECIP BIOVENTURES II LLC , New York , NY ( US) U . S . PATENT DOCUMENTS 4 , 939 , 130 A 7 / 1990 Jaeggi et al. ( 72 ) Inventor : Herriot Tabuteau , New York , NY (US ) 5 ,869 , 471 A 2 / 1999 Hovancik et al . 6 ,015 , 801 A 1 / 2000 Daifotis 6 , 419, 955 B1 7 / 2002 Gabel et al. ( 73 ) Assignee: ANTECIP BIOVENTURES II LLC , 6 , 943 , 155 B2 9 / 2005 Lichtenberger New York , NY (US ) 7 , 645 , 459 B2 1 / 2010 Dansereau 7 , 658, 939 B2 2 / 2010 Oshlack et al. ( * ) Notice : Subject to any disclaimer , the term of this 7 ,704 , 977 B2 4 / 2010 Leonard patent is extended or adjusted under 35 8 , 053 , 429 B2 11/ 2011 Cumming et al. U . S . C . 154 (b ) by 0 days . 8 , 119 , 159 B2 2 / 2012 Cumming et al. 8 ,323 , 689 B2 12 /2012 Cumming et al . This patent is subject to a terminal dis 8 , 323 , 690 B2 12 / 2012 Cumming et al. claimer . 8 ,399 , 023 B2 3 /2013 Hanna et al . 8 , 772 , 267 B2 7/ 2014 Pappagallo 8 , 802 , 658 B2 8 / 2014 Tabuteau ( 21) Appl. No .: 15 /403 , 073 8 , 822 , 436 B1 9 / 2014 Tabuteau 8 , 828, 431 B2 9 /2014 Cumming et al. ( 22 ) Filed : Jan . 10 , 2017 8 , 835 ,650 B1 9 / 2014 Tabuteau 8 , 859 , 530 B2 10 / 2014 Desai (65 ) Prior Publication Data 8 , 865, 757 B1 10 / 2014 Tabuteau 8 , 883 , 201 B2 11 / 2014 Leonard US 2017/ 0128470 A1 May 11 , 2017 8 , 883 , 203 B2 11 / 2014 Leonard 8 , 901, 161 B1 12 / 2014 Tabuteau 8 . 901. 162 B 12 / 2014 Tabuteau Related U .S . Application Data 8 , 933 , 057 B2 1 /2015 Hanna et al. 8 ,962 , 599 B1 2 / 2015 Tabuteau (63 ) Continuation - in -part of application No . 15 /043 , 141, 9 , 006 , 279 B1 4 / 2015 Tabuteau filed on Feb . 12 , 2016 , now Pat. No . 9 , 585 , 902 , which 9 , 034 , 889 B2 5 / 2015 Tabuteau is a continuation of application No. 14 /279 ,213 , filed 9 , 079 , 927 B1 7 / 2015 Tabuteau 9 ,149 ,487 B2 10 /2015 Tabuteau on May 15 , 2014 , now Pat . No . 9 ,278 , 106 , which is 9 , 169 ,279 B2 10 /2015 Hanna et al . a continuation of application No . 14 / 063 , 979 , filed on 9 ,205 ,045 B1 12 / 2015 Tabuteau Oct. 25 , 2013 , now Pat . No . 8 , 802 ,658 , which is a continuation - in -part of application No. 13 /894 , 274 , ( Continued ) filed on May 14 , 2013 , now abandoned , application No. 15 /403 , 073 , which is a continuation - in -part of FOREIGN PATENT DOCUMENTS application No . 15 /352 ,461 , filed on Nov . 15 , 2016 , CN 101259133 3 /2008 which is a continuation - in - part of application No. EP 1057488 12 /2000 PCT/US2015 /032739 , filed on May 27 , 2015 . (Continued ) (60 ) Provisional application No .61 / 646 ,538 , filed on May OTHER PUBLICATIONS 14 , 2012 , provisional application No . 61/ 647 , 478 , filed on May 15 , 2012 , provisional application No. Ian R Reid , Kenneth Lyles , Guoqin Su , Jacques P Brown, John P 61 /654 ,292 , filed on Jun . 1 , 2012 , provisional Walsh , Javier del Pino -Montes , Paul D Miller, William D Fraser, application No . 61/ 654 , 383 , filed on Jun . 1 , 2012 , Susan Cafoncelli , Christina Bucci- Rechtweg, and David J Hosking , provisional application No. 61/ 655 , 527 , filed on Jun . A Single Infusion of Zoledronic Acid Produces Sustained Remis 5 , 2012 , provisional application No . 61 /655 , 541 , filed sions in Paget Disease : Data to 6 . 5 Years , Journal of Bone and on Jun . 5 , 2012 , provisional application No. Mineral Research , vol. 26 , No . 9, S. * 61/ 764, 563 , filed on Feb . 14 , 2013 , provisional (Continued ) application No. 61/ 762, 225 , filed on Feb . 7 , 2013 , provisional application No . 61/ 767, 647 , filed on Feb . Primary Examiner — Sarah Pihonak 21 , 2013, provisional application No. 61 /767 ,676 , Assistant Examiner — Jason Deck filed on Feb . 21, 2013 , provisional application No . (74 ) Attorney , Agent, or Firm — Mashoff Brennan 61/ 803 ,721 , filed on Mar. 20 , 2013 . Laycock Gilmore ; Brent A . Johnson ; Yuefen Zhou ( 57 ) ABSTRACT (51 ) Int. Cl. A61K 31/ 675 ( 2006 .01 ) Oral dosage formsof osteoclast inhibitors , such as nitrogen A61K 31/ 56 ( 2006 .01 ) containing bisphosphonates , such as zoledronic acid in an A61K 9 / 00 ( 2006 .01 ) acid or a salt form , or in a molecular complex can be used (52 ) U . S . CI. to treat or alleviate pain or related conditions, such as CPC ...... A61K 31 /675 (2013 . 01 ) ; A61K 9 /0053 treating pain associated with Paget' s disease of bone . (2013 . 01 ) ; A61K 31/ 56 (2013 . 01 ) 30 Claims, 17 Drawing Sheets US 10 ,016 , 446 B2 Page 2

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Patent Jul. 10 , 2018 Sheet 1 of 17 US 10 ,016 ,446 B2

uma

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FIG . 1 U . S . Patent Jul. 10 , 2018 Sheet 2 of 17 US 10 , 016 ,446 B2

60 %

50 %

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20 %

10 %

Zoledronic Zoledronic acid 54 acid 360 mg /m mg/ m convencioniranciscussionsrennsinsvarsrecensionersverenigingen FIG . 2A U . S . Patent Jul. 10 , 2018 Sheet 3 of 17 US 10 ,016 ,446 B2

PainThreshold(e) wwwwwwwwwwwwwwwwwwwwwwwwm 150 waar mang Normal Paw Vehicle Zoledronic Zoledronic acid 54 mg/ m acid 360 mg/ m2

FIG . 2B U . S . Patent Jul. 10 , 2018 Sheet 4 of 17 US 10 ,016 ,446 B2

%Changevs.control entinsson massasasimasalassab

Pain EXYa Warmth Weight Pain Edema Warmth Bearingweight FIG . 3 U . S . Patent Jul. 10 , 2018 Sheet 5 of 17 US 10 ,016 ,446 B2

: . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : . : .

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WeightBearing(%) hopPro Vehicle Zoledronic acid FIG . 5 U . S . Patent Jul. 10 , 2018 Sheet 7 of 17 US 10 ,016 ,446 B2

PawThicknessChange(mm)

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Solubility(g/100mL) 5?

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wiw 150 mg - Disodium zoledronate wanne 150 ng- Zoledronic acid ZoledonicAcidPlasmaConcentration(ng/ml)

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e . meestemensen P . IV TabletHardness(kPa) minu ä .* 7 * * '* ...... * testubetototaletodomuieteistesistentechetutelatodeoteisinikuitotutotododetectcomeintototurtointerventotodososteisinisstatedtodoeltitoisirichincostode . co 50 mg Disodium Salt

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* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * + + + + + + + + + + + + + + 1000 2000 3000 4000 5000 6000 Compression Force ( psi) FIG . 9 atent Jul. 10 , 2018 Sheet 11 of 17 US 10 , 016 ,446 B2

Change in VAS Pain Score Compared to placebo with Zoledronic Acid Treatment QARSIGrade 0 QARSI Grade 1 -2

VASChangevs.Placebomm()

- 16 ,0

FIG . 10 U . S . Patent Jul. 10 , 2018 Sheet 12 of 17 US 10 , 016 ,446 B2

Change in VAS Pain Score Compared to Baseline with Zoledronic Acid Treatment OARSI Grade 0 OARSI Grade 1 OARSI Grade 2 0 . 0 ......

5 . 0

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-20 . 0

- 25 . 0

FIG . 11 atent Jul. 10 , 2018 Sheet 13 of 17 US 10 , 016 ,446 B2

Change in VAS Pain Score Compared to placebo with Zoledronic Acid Treatment at Three Months Baseline VAS X 50 + All patients Baseline VAS 2 50 QARSI Grade 0 QARSI Grade 0

VASChangevs.Placebo(mm)

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FIG . 12 U . S . Patent Jul. 10 , 2018 Sheet 14 of 17 US 10 , 016 ,446 B2

Change in BML Lesion Size Compared to Placebo with Zoledronic Acid Treatment QARSIGrade 0 OARSI Grade 1 - 2 i - 20 .0

-40 . 0 : : :: : :: : : : : : :: : : : : : : : : : : : : : ::

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BMLAreaChangevs.Placebo(mm) . . : . : . : . : . : . : . : . : . : . : . : . : .

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FIG . 13 atent Jul. 10 , 2018 Sheet 15 of 17 US 10 , 016 ,446 B2

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Baseline Wees Weeks Wed 6 Week 3 Week * Piste after fracture FIG . 14 U . S . Patent Jul. 10 , 2018 Sheet 16 of 17 US 10 , 016 ,446 B2

www . WeightBearing(%) litenso como tais ensom Here were the vehics to Newslee xx?g??: ?????? the western tentangasian

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- Reversal of Pain Threshold

- be

- - %ReversalofvonFreypainThreshold geleiden

- O weeks 4 weeks

- Time Between Fracture and Oral Administration of

- Zoledronic Acid

FIG . 16 US 10 , 016 , 446 B2

COMPOSITIONS FOR ORAL disodium salt form is present in a lower molar amount than ADMINISTRATION OF ZOLEDRONIC ACID would be present if the zoledronic acid were in the diacid OR RELATED COMPOUNDS FOR form ; and wherein the zoledronic acid in the disodium salt TREATING PAGET ' S DISEASE OF BONE form has an improved bioavailability as compared to the 5 zoledronic acid in the diacid form to the extent that the lower CROSS - REFERENCE TO RELATED molar amount of the disodium salt in the dosage form does APPLICATIONS not reduce the amount of zoledronic acid delivered to the plasma of a mammal. This application is a continuation - in -part of U . S . patent Although an oral dosage form with enhanced bioavail application Ser. No. 15 / 043 , 141 , filed Feb . 12 , 2016 , which 10 ability with respect to the bisphosphonate compound can be is a continuation of U . S . patent application Ser. No. 14 /279 , used , the treatment can also be effective using an oral dosage 213 , filed May 15 , 2014 , now U . S . Pat. No. 9 ,278 , 10606 ., 1form that includes a bisphosphonate compound , such as which is a continuation of U . S . patent application Ser . No . zoledronic acid , wherein the bioavailability of the bisphos 14 / 063, 979 , filed Oct. 25 , 2013 , now U . S . Pat. No . 8 , 802 , phonate is unenhanced , or is substantially unenhanced . 658 , which is a continuation - in - part of U . S . patent applica - 15 Some embodiments include a method of relieving inflam tion Ser. No. 13 /894 ,274 , filed May 14 , 2013 , now aban - matory pain comprising administering an oral dosage form doned , which claims the benefit of U . S . Prov . App . Nos . containing zoledronic acid to a mammal in need thereof, 61/ 646 ,538 , filed May 14 , 2012 ; 61/ 647 ,478 , filed May 15 , wherein the mammal experiences significant pain relief 2012 ; 61/ 654 , 292 , filed Jun . 1 , 2012 ; 61/ 654 , 383 , filed Jun . more than 3 hours after administration of the dosage form . 1 , 2012 ; 61/ 655 ,527 , filed Jun . 5 , 2012 ; 61 /655 , 541, filed 20 Some embodiments include a method of relieving pain Jun . 5 . 2012 ; 61 / 764 ,563 , filed Feb . 14 , 2013 ; 61/ 762, 225 , associated with an arthritis comprising administering an oral filed Feb . 7 , 2013 ; 61 / 767, 647 , filed Feb . 21 , 2013 ; 61 / 767 , dosage form containing zoledronic acid to a human being in 676 , filed Feb . 21 , 2013 ; and 61 / 803 ,721 , filed Mar. 20 , need thereof. 2013 ; this application is also a continuation - in -part of U . S . Some embodiments include a method of treating complex patent application Ser. No . 15 /352 , 461 , filed Nov . 15 , 2016 , 25 regional pain syndrome comprising administering an oral which is a continuation - in -part of International Pat . App . dosage form containing zoledronic acid to a mammal in No. PCT /US2015 /032739 , filed May 27 , 2015 ; any of the need thereof. applications, U . S . patents issued from , or U .S . publications Some embodiments include an oral dosage form compris of any of the above applications are incorporated by refer - ing zoledronic acid , wherein the oral bioavailability of ences in their entirety . 30 zoledronic acid is substantially unenhanced . For example , in some embodiments, the oral bioavailability in the dosage SUMMARY form is about 0 .01 % to about 4 % . Some embodiments include a pharmaceutical product Bisphosphonate compounds are potent inhibitors of comprising more than one unit of an oral dosage form osteoclast activity , and are used clinically to treat bone - 35 described herein . In some embodiments , each unit of the oral related conditions such as osteoporosis and Paget ' s disease dosage form contains about 1 mg to about 50 mg of of bone; and cancer- related conditions including multiple zoledronic acid . myeloma, and bone metastases from solid tumors . They Some embodiments include a method of relieving inflam generally have low oral bioavailability . matory pain comprising administering an oral dosage form Patchy osteoporosis and bone marrow edema may result 40 containing zoledronic acid to a mammal in need thereof . from osteoclast hyperactivity . Zoledronic acid is a potent In some embodiments , the mammal receives a total inhibitor of bone resorption and osteoclast activity . Nitrogen monthly dose of zoledronic acid that is about 800 mg/ m ? or containing bisphosphonates, such as zoledronic acid , also less . inhibit the mevalonate pathway in the osteoclast thereby In some embodiments , the dosage form contains about 10 interrupting normal osteoclast function . 45 mg/ m² to about 20 mg/ m² based upon the body surface area It has been discovered that oral dosage forms of bispho of the mammal. sphonate compounds , such as zoledronic acid , can be used Some embodiments include a method of relieving inflam to treat or alleviate pain or related conditions . matory1114 pain comprising orally administering zoledronic acid Some embodiments include a method of enhancing the to a mammal in need thereof. oral bioavailability of zoledronic acid comprising orally 50 In some embodiments , about 300 mg/ m² to about 600 administering a dosage form containing zoledronic acid in mg/ m - of zoledronic acid is administered per month , based the disodium salt form . upon the body surface area of the mammal. Some embodiments include a dosage form comprising In some embodiments , about 50 mg/ m² to about 600 zoledronic acid in the disodium salt form , wherein the mg/ m² of zoledronic acid is administered per month , based bioavailability , in a mammal, of zoledronic acid in the 55 upon the body surface area of the mammal. disodium salt form is greater than the bioavailability of Some embodiments include administering an osteoclast zoledronic acid in the diacid form would be in the same inhibitor , such as a bisphosphonate , including zoledronic dosage form . acid , neridronic acid , etc. to inhibit the development of pain , Some embodiments include a dosage form comprising unweighting , and edema when administered early such as zoledronic acid in an acid or a salt form , such as the 60 when a precipitating event such as fracture occurs , wherein disodium salt form , wherein the dosage form contains an the precipitating event is associated with CRPS . amount of zoledronic acid in the disodium salt form that Some embodiments include administering an osteoclast provides an area under the plasma concentration curve of inhibitor, such as a bisphosphonate, including zoledronic zoledronic acid of about 4 ng . h /mL to about 2000 ng - h /mL acid , neridronic acid , etc . to reverse established allodynia to a human being to which the dosage form is administered . 65 and unweighting when administered at least 4 weeks after a Some embodiments include a dosage form comprising precipitating event such as fracture that is associated with zoledronic acid in the disodium salt form , wherein the CRPS . US 10 , 016 ,446 B2 BRIEF DESCRIPTION OF DRAWINGS DETAILED DESCRIPTION FIG . 1 is a plot of pain compression thresholds in a rat model of inflammatory pain using three different doses of Inhibitors of osteoclast activity include bisphosphonate zoledronic acid . Measurements were taken at baseline (BL ) compounds such as pamidronate or pamidronic acid , and at various time points after dosing on the days indicated . neridronate or neridronic acid , olpadronate or olpadronic FIG . 2A is a graph depicting reversal of arthritis pain for two different doses of zoledronic acid in a rat model of acid , alendronate or alendronic acid , incadronate or incad arthritis pain . 10 ronic acid , ibandronate or ibandronic acid , risedronate or FIG . 2B is a graph depicting pain thresholds for two risedronic acid , cimadronate or cimadronic acid , zoledronate different doses of zoledronic acid in a rat model of arthritis pain . or zoledronic acid , etidronate or etidronic acid , clodronate or FIG . 3 is a graph summarizing the results for vehicle and 15 clodronic+ acid , tiludronate or tiludronic acid , etc . zoledronic acid treated rats in a rat model of complex RANK / RANKL antagonists may be inhibitors of osteo regional pain syndrome. FIG . 4 depicts hindpaw pain thresholds for vehicle and clast activity . RANK /RANKL antagonists include but are zoledronic acid treated rats in a rat model of complex not limited to OPG (osteoprotegerin ) or a variant thereof , an regional pain syndrome. 20 anti- RANKL antibody such as denosumab, a monoclonal FIG . 5 depicts weight bearing for vehicle and zoledronic anti- RANKL antibody, a small interfering RNA, a micro acid treated rats in a rat model of complex regional pain syndrome. RNA, a precursor molecule , a ribozyme, an antisense FIG . 6 depicts paw thickness change for vehicle and 25 nucleic acid , or an aptamer targeting RANKL . Antibodies zoledronic acid treated rats in a rat model of complex such as AB -25E9 , smallmolecules , small interfering RNAs, regional pain syndrome. microRNAs, precursor molecules , ribozymes , antisense FIG . 7 depicts the aqueous solubility of disodium zole dronate tetrahydrate as compared to the diacid form of 30 nucleic acids, or aptamers that target the cell -surface protein zoledronic acid . Siglec- 15 may be osteoclast inhibitors . FIG . 8 depicts the plasma concentration of zoledronic Some Bruton 's tyrosine kinase (BTK ) inhibitors may be acid in dogs over time after administration of 150 mg of the disodium salt form of zoledronic acid and the diacid formnof of inhibitorsinhibitors of osteoclast activityactivity . BTKBlk inhibitors can include zoledronic acid . 35 ONO -4059 ; ibrutinib ; Benzo [b ] thiophene - 2 - carboxamide, FIG . 9 depicts the compressibility of dosage forms con - N - [ 3 - [ 6 - [ [ 4 - [ (2R ) - 1 , 4 -dimethyl - 3 -oxo - 2 -piperazinyl ]phe taining zoledronic acid in the disodium salt form as com pared to the diacid form . nyl] amino ]- 4, 5 -dihydro -4 -methyl - 5 -oxo -2 -pyrazinyl ) - 2 FIG . 10 depicts the change in VAS pain score comparedod 2040 memethylphenyl ] - 4 , 5 ,6 , 7 - tetrahydro -( GDC -0834 ) ; RN -486 ; to placebo at three months with zoledronic acid treatment in Benzamide , 4 -( 1 , 1 - dimethylethyl ) - N -[ 3 - [ 8 -( phenylamino ) patients with osteoarthritis of the knee , bone marrow lesions, and different degrees of joint space narrowing. imidazo [ 1, 2 -a ]pyrazin -6 -yl ] phenyl ] - ( CGI -560 ); Benz FIG . 11 depicts the change in VAS pain score compared amide , N -[ 3 -[ 4, 5- dihydro -4 - methyl - 6 -[ [ 4 -( 4 -morpholinyl to baseline at three months with zoledronic acid treatment in carbonyl )phenyl ] amino ] - 5 -oxo - 2 - pyrazinyl] - 2 patients with osteoarthritis of the knee , bonemarrow lesions, methylphenyl] - 4 - ( 1 , 1 - dimethylethyl) - (CGI - 1746CAS and different degrees of joint space narrowing . FIG . 12 depicts the change in VAS pain score compared Registry No. 910232 -84 - 7) ; HM -71224 ; 2- Propenamide , to placebo at three months with zoledronic acid treatment in 50 N - L3 - [ [5 - fluoro - 2 -( [ 4 -( 2 -methoxyethoxy )phenyl?amino ] -4 different subgroups of patients with osteoarthritis of the knee pyrimidinyl ]amino ] phenyl] - ( CC -292 , CAS Registry No . and bone marrow lesions. FIG . 13 depicts the change in BML lesion size compared 1202757- 89 - 8 ); 2 -Pyridinecarboxamide , 4 -[ 4 -[ [5 -fluoro -4 to placebo at six months with zoledronic acid treatment in . . [[ 3 - [( 1 - oxo - 2 -propen - 1 -yl )amino ]phenyl ]amino ] - 2 - pyrim patients with osteoarthritis ofthe knee , bone marrow lesions, ” idinyl ]amino ] phenoxy ]- N -methyl - (CNX - 774, CAS Regis and different degrees of joint space narrowing . try No. 1202759- 32 -7 ), AVL - 101 (CAS Registry No . FIG . 14 depicts hindpaw pain thresholds for vehicle and zoledronic acid treated rats in a rat model of complex 1552307 - 34 - 2 ) , AVL - 291 (CAS Registry No. 1552307 - 35 regional pain syndrome . 60 3 ) ,and AVL -292 (CAS Registry No. 1552307 -36 - 4 ), [ N - (2 FIG . 15 depicts weight bearing for vehicle and zoledronic chloro -6 -methylphenyl ) -2 -( 6 -( 4 -( 2- hydroxyethyl ) piper acid treated rats in a rat model of complex regional pain syndrome. azin - 1 - yl) - 2 -methylpyrimidin - 4 - ylamino )thiazole - 5 FIG . 16 depicts hindpaw pain thresholds for rats admin - 65 carboxamide] (dasatinib ), alpha - cyano -beta -hydroxy -beta istered zoledronic acid at the time of fracture as compared to methyl -N - (2 ,5 - bromophenyl ) propenamide (LFM -A13 ) , rats administered zoledronic acid four weeks after fracture . and ONO - WG - 307 . US 10 . 016, 446 B2

. Br . 0 OH

Z 81111Z

LFM - A13

NH .

Ibrutinib

HN M NH GDC- 0834 H ) .

Dasatinib

* CGI -560

' CGI- 1746?? US 10 , 016 , 446 B2 -continued N

cirCC - 292

NH CNX - 774

Inhibitors of osteoclast activity may be used for a number mammal being treated is not suffering from cancer . In some of medical purposes, such as treatment of undesirable con - embodiments , the mammal being treated is not suffering ditions or diseases , including pain relief. This may be 20 from osteoporosis . accomplished in many instances by administration of oral For example , zoledronic acid or another bisphosphonate dosage forms. Generally , an oral dosage form comprising a may be administered orally to relieve musculoskeletal pain bisphosphonate such as zoledronic acid is administered including low back pain , and pain associated with rheuma orally to a mammal, such as a human being , at least once , to toid arthritis , juvenile rheumatoid arthritis , osteoarthritis , treat a disease or condition , or to relieve pain . erosive osteoarthritis , sero -negative (non - rheumatoid ) The compounds containing Ion 1 or Ion 2 may also be arthropathies, non - articular rheumatism , peri - articular dis osteoclast inhibitors : orders , axial spondyloarthritis including ankylosing spon dylitis , Paget' s disease , fibrous dysplasia , SAPHO syn Ion 1 30 drome, transient osteoarthritis of the hip , vertebral crush 7 + fractures , osteoporosis , etc . In some embodiments , enhanced PO3H2 1 bioavailability of the zoledronic acid may be achieved in treating one of these conditions by administering a dosage PO3H2 form comprising zoledronic acid in the form of a disodium OH a OHforma ] 35 L salt. This may allow a reduced molar amount of the diso Ion 2 dium salt to be used as compared to what would be used with PO3H2 1 the diacid form . PO3H2 An osteoclast inhibitor, such as a bisphosphonate , e . g . PO3H2 zoledronic acid , may also be used to treat bone fractures or OH 40 to enhance the healing of bone fractures . In some embodi ments , a human being that is treated for CRPS , suffered from a precipitating injury such as a bone fracture associated with The term “ treating” or “ treatment” broadly includes any the CRPS at least 4 weeks , at least 8 weeks, at least 12 kind of treatment activity, including the diagnosis , cure, weeks, at least six months , or at least 1 year before first mitigation , or prevention of disease in man or other animals , 45 administering an osteclast inhibitor, such as a bisphospho or any activity that otherwise affects the structure or any nate , including zoledronic acid , neridronic acid , etc . function of the body of man or other animals . Examples of a precipitating event include a fracture , a An oral dosage form of a bisphosphonate such as zole - cutting injury , a scratch , a puncture injury , etc . dronic acid may be used to treat, or provide relief of, any In some embodiments , zoledronic acid or another bispho type of pain including, but not limited to , inflammatory pain , 50 sphonate may also be administered orally to relieve neuro arthritis pain , complex regional pain syndrome, lumbosacral pathic pain , including diabetic peripheral neuropathy , post pain , musculoskeletal pain , neuropathic pain , chronic pain , herpetic neuralgia , trigeminal neuralgia , cancer -related pain , acute pain , postoperative pain , etc . In monoradiculopathies , phantom limb pain , and central pain . some instances, pain reliefmay be palliative, or pain relief Other causes of neuropathic pain include cancer- related may be provided independent of improvement of the disease 55 pain , lumbar nerve root compression , spinal cord injury , or condition or the underlying cause of the disease or post - stroke pain , central multiple sclerosis pain , HIV - asso condition . For example , although the underlying disease ciated neuropathy, and radio - therapy or chemo - therapy asso may not improve , or may continue to progress , an individual c iated neuropathy . In some embodiments , enhanced bio suffering from the disease may experience pain relief . In availability of the zoledronic acid may be achieved in some embodiments, enhanced bioavailability of the zole - 60 treating one of these conditions by administering a dosage dronic acid may be achieved in treating one of these con - form comprising zoledronic acid in the form of a disodium ditions by administering a dosage form comprising zole - salt . This may allow a reduced molar amount of the diso dronic acid in the form of a disodium salt . This may allow dium salt to be used as compared to what would be used with a reduced molar amount of the disodium salt to be used as the diacid form . compared to what would be used with the diacid form . 65 In some embodiments , zoledronic acid or another bispho In some embodiments , the mammal being treated is not sphonate may be administered orally to relieve inflammatory suffering from bone metastasis . In some embodiments , the pain including musculoskeletal pain , arthritis pain , and US 10 ,016 , 446 B2 10 complex regional pain syndrome. In some embodiments , In some embodiments , a person being treated for arthritis , enhanced bioavailability of the zoledronic acid may be such as with zoledronic acid , has osteoarthritis of the knee achieved in treating one of these conditions by administering associated with bone marrow lesions. a dosage form comprising zoledronic acid in the form of a In some embodiments , an inhibitor of osteoclast activity disodium salt . This may allow a reduced molar amount of 5 can be used to treat bone marrow lesions . the disodium salt to be used as compared to what would be In some embodiments , an inhibitor of osteoclast activity used with the diacid form . can be used to treat bone marrow lesions of the knee , Examples ofmusculoskeletal pain include low back pain ; shoulder, ankle , wrist , hand , fingers , spine , or hip . and pain associated with vertebral crush fractures, fibrous Commonly used measures of pain intensity include the dysplasia , osteogenesis imperfecta , Paget' s disease of bone , visual analog scale (VAS ) and the numerical rating scale transient osteoporosis , and transient osteoporosis of the hip . (NRS ) . With the VAS approach , patients rate the severity of Arthritis refers to inflammatory joint diseases that can be their pain by marking a point on a 10 - cm (or 100 mm ) VAS associated with pain . Examples of arthritis pain include pain ( 0 = no pain and 10 = worst possible pain ) . With the NRS associated with osteoarthritis , erosive osteoarthritis , rheu - 16 approach , patients rate the severity of their pain by verbally matoid arthritis , juvenile rheumatoid arthritis , sero -negative responding to a 10 -point NRS ( 0 = no pain and 10 = worst ( non - rheumatoid ) arthropathies, non - articular rheumatism , possible pain ). VAS and NRS scores have been shown to be peri - articular disorders, neuropathic arthropathies including strongly correlated (slope of regression line , 1 .01 ) , indicat Charcot ' s foot, axial spondyloarthritis including ankylosing ing that a score on the 10 -cm VAS is equivalent to the same spondylitis , and SAPHO syndrome. 20 score on 10 - point NRS (Bijur P E et al. Acad Emerg Med In some embodiments , a human being that is treated for 2003 ; 10 : 390 - 392 ) . For example, a VAS score of 5 cm (or 50 a disease or condition , such as an inflammatory condition , mm ) is equivalent to an NRS score of 5 . Knee pain in a e .g . arthritis or CRPS , by an osteoclast inhibitor, such as a person with a VAS score of 5 cm or 50 mm or higher , or an bisphosphonate , e . g . an oral dosage form of zoledronic acid , NRS score of 5 or higher, may be referred to herein as has an age of at least 18 years , at least 50 years ( including 25 moderate to severe knee pain . a male of at least 50 years ), a postmenopausal female , about In some embodiments , the patient suffering from pain , 10 years to about 90 years, about 20 years to about 80 years , inflammation , a similar condition , or any of the conditions about 30 years to about 75 years , about 40 years to about 70 described herein , has an NRS of 5 or greater, or a VAS of 5 years , about 1 year to about 16 years, or about 80 years to cm or greater. In some embodiments , the patient has an NRS about 95 years . In some embodiments , the human being is a 30 of 4 or greater, or a VAS of 4 cm or greater. In some male at least 50 years of age or a postmenopausal female , embodiments , the patient has an NRS of 6 or greater , or a with knee osteoarthritis (OA ) and bone marrow lessions VAS of 6 cm or greater. In some embodiments , the patient (BMLs ) , having moderate or worse knee pain . has an NRS of 7 or greater , or a VAS of 7 cm or greater . In In some embodiments , a human being that is treated for some embodiments , the patient has an NRS of about 1 , about a disease or condition , such as an inflammatory condition , 35 2 , about 3 , about 4 , about 5 , about 6 , about 7 , about 8 , about e . g . arthritis , low back pain , or CRPS , by an osteoclast 9 , or about 10 . In some embodiments , the patient has a VAS inhibitor , such as a bisphosphonate , e . g . an oral dosage form of about 1 cm , about 2 cm , about 3 cm , about 4 cm , about of zoledronic acid , has suffered from the inflammatory 5 cm , about 6 cm , about 7 cm , about 8 cm , about 9 cm , or condition for at least 1 month , at least 2 months, at least 3 about 10 cm . months , at least 6 months , or at least 1 year. 40 For knee pain or pain associated with bone marrow In some embodiments, the arthritis affects a knee , an lesions, in some embodiments , treatment with a nitrogen elbow , a finger, a wrist , a shoulder, an ankle , the spine , or a containing bisphosphonate such as zoledronic acid may hip . decrease the visual analog (VAS ) pain score measured using For treatment of arthritis or joint pain , such as knee pain , a 100 mm scale , by at least about 5 mm , at least about 8 mm , in some embodiments the person being treated has OARSI 45 at least about 10 mm , at least about 15 mm , up to about 50 Grade 0 , or Kellgren and Lawrence Grades 0 or 1 , joint mm , or up to about 100 mm . In some embodiments, the VAS space narrowing . score , may be decreased by at least about 5 mm , at least In some embodiments , the person has lesions , such as about 8 mm , at least about 10 mm , at least about 15 mm , up bone marrow lesions . In some embodiments the person to about 50 mm , or up to about 100 mm , as compared to a being treated for bone marrow lesions has normal joint space 50 placebo . knee pain , OARSI Grade 0 , or Kellgren and Lawrence Treatment with a nitrogen - containing bisphosphonate Grades 0 or 1 , joint space narrowing . such as zoledronic acid may decrease the numerical rating In some embodiments , the person has baseline pain inten scale ( NRS ) pain score measured using a 0 - 10 scale , by at sity of 5 or greater measured using the 0 - 10 numerical rating least about 0 . 1 , at least about 0 . 5 , at least about 0 . 8 , at least scale (NRS ) , or 50 mm or greater using the 100 mm visual 55 about 1 , at least about 1 . 5 , up to about 5 , or up to about 10 . analog scale ( VAS ) . In some embodiments the person being In some embodiments, the NRS score may be decreased by treated for pain has normal joint space knee pain , OARSI at least about 0 . 1 , at least about 0 . 5 , at least about 0 . 8 , at least Grade 0 , or Kellgren and Lawrence Grades 0 or 1 , joint about 1 , at least about 1 . 5 , up to about 5 , or up to about 10 , space narrowing . as compared to a placebo . Bone marrow lesions (BMLs ) include regional bone mar - 60 In some embodiments , an inhibitor of osteoclast activity row signal intensity alterations on magnetic resonance imag - can be used to reduce the size of bone marrow lesions . The ing (MRI ) . BMLs can be present in the knee and can be an area of the lesions may be measured as the total area of all important feature of osteoarthritis of the knee . BMLs have lesions or as the area of any one lesion . In some embodi also been described in other rheumatic conditions such as ments , the total area includes the medial tibial area , the rheumatoid arthritis , osteonecrosis, ankylosing spondylitis , 65 medial femoral area , the lateral tibial area , and the lateral and transient osteoporosis of the hip and are often referred femoral area . In some embodiments the bone marrow lesion to as bone marrow edema (BME ) . in located in the patella . US 10 ,016 , 446 B2 In some embodiments , the use of an inhibitor of osteoclast the bone marrow lesions of at least about 100 mm². In some activity achieves a reduction in the total area of the bone embodiments , the reduction in total area is at least about 50 marrow lesions of at least about 240 mm². In some embodi - mm ? , at least about 60 mm ? , at least about 80 mm², at least ments , the reduction in total area is at least about 220 mm², about 85 mm2, at least about 90 mm², at least about 100 at least about 200 mm , at least about 150 mm , at least 5 mm , at least about 105 mm ” , at least about 110 mm ” , or at about 100 mm - , or at least about 50 mm . In some embodi- least about 115 mm . In some embodiments , the reduction in ments , the reduction in size of bone marrow lesions repre - size of bone marrow lesions represents a reduction relative sents a reduction relative to baseline of at least about 10 % , to baseline of at least about 10 % , at least about 20 % , at least at least about 20 % , at least about 30 % , at least about 40 % , about 30 % , at least about 40 % , at least about 50 % , at least at least about 50 % , at least about 60 % , at least about 70 % at 10 about 60 % , at least about 70 % at least about 80 % , at least least about 80 % , at least about 90 % , or about 100 % . In some about 90 % , or about 100 % . In some embodiments , the embodiments , the reduction in area of bone marrow lesions reduction in area of bone marrow lesions represents an represents an improvement relative to placebo of at least improvement relative to placebo of at least about 10 % , at about 10 % , at least about 20 % , at least about 30 % , at least least about 20 % , at least about 30 % , at least about 40 % , at about 40 % , at least about 50 % , at least about 60 % , at least 15 least about 50 % , at least about 60 % , at least about 70 % , at about 70 % , at least about 80 % , at least about 90 % , at least least about 80 % , at least about 90 % , at least about 100 % , at about 100 % , at least about 120 % , at least about 150 % , at least about 115 % , at least about 125 % , at least about 135 % , least about 170 % , at least about 200 % , at least about 250 % , at least about 150 % , at least about 170 % , at least about at least about 300 % , at least about 350 % , at least about 200 % , at least about 250 % , at least about 300 % , at least 400 % , or at least about 450 % . In some embodiments , the use 20 about 350 % , at least about 400 % , or at least about 450 % . In of an inhibitor of osteoclast activity inhibits an increase in some embodiments , the use of an inhibitor of osteoclast the size of the bone marrow lesions over time. activity inhibits an increase in the size of bone marrow Joint space narrowing (JSN ) is typically graded using the lesions over time. Osteoarthritis Research Society International (OARSI ) atlas In some embodiments , an inhibitor of osteoclast activity , criteria , or the Kellgren and Lawrence ( K / L ) system . The 25 such as a nitrogen - containing bisphosphonate , including e . g . OARSI atlas criteria grades JSN using a 0 - 3 scale with zoledronic acid , minodronic acid , etc ., is used to treat Grade O indicating an absence of JSN , and Grades 1 , 2 and fibromyalgia . 3 indicating mild , moderate , and severe JSN , respectively According to some embodiments , administration of an ( Altman and Gold , Osteoarthritis Cartilage 2007 ; 15 ( Suppl inhibitor of osteoclast activity achieves a reduction in pain A ) :A1 - A56 ) . The K / L system grades JSN using a 0 - 4 scale 30 that lasts at least about one month , two months, three with Grade O indicating an absence of JSN , Grade 1 indi- months, four months, six months, or even at least about cating doubtful JSN , and grades 2 , 3 and 4 indicating twelve months . According some embodiments , administra minimal, moderate , and severe JSN , respectively (Kellgren tion of an inhibitor of osteoclast activity achieves a reduc and Lawrence, Ann Rheum Dis 1957 ; 16 : 494 - 502 ) . Based on tion in pain that is observed at greater than three hours , at these criteria , OARSI Grade 0 ( absence of JSN ) , approxi- 35 about one day , at about two to about five days , at about one mates K / L Grades 0 - 1 (absence of, or doubtful presence of week , at about two weeks, at about three weeks, at about one JSN ) . Knee pain in a person having OARSI Grade ( or K / L month , at about five weeks , at about six weeks, at about Grade or 1 JSN in the knee where the pain occurs may be seven weeks , at about two months, at about nine weeks , at referred to herein as a " normal joint space knee pain ." about ten weeks, at about eleven weeks , at about three In some embodiments for patients having OARSI Grade 40 months, at about four months , at about six months , or at O or K / L Grades 0 - 1 JSN , the use of an inhibitor of osteoclast about twelve months after administration of the inhibitor of activity achieves a reduction in the total area of the bone osteoclast activity . marrow lesions of at least about 240 mm². In some embodi According some embodiments , administration of an ments , the reduction in total area is at least about 220 mm , inhibitor of osteoclast activity achieves a reduction in pain at least about 200 mm , at least about 150 mm , at least 45 that is observed at greater than three hours, but at or before about 100 mm , or at least about 50 mm . In some embodi - one week , two weeks , three weeks , four weeks, five weeks , ments , the reduction in size of bone marrow lesions repre six weeks , seven weeks , eightweeks , nine weeks, ten weeks, sents a reduction relative to baseline of at least about 10 % , eleven weeks , twelve weeks, four months, five months, or at least about 15 % , at least about 20 % , at least about 25 % , six months5 . at least about 30 % , at least about 35 % , at least about 40 % , 50 According some embodiments , administration of an at least about 45 % , at least about 50 % , at least about 60 % , inhibitor of osteoclast activity achieves a reduction in pain at least about 70 % at least about 80 % , at least about 90 % , or that is observed at greater than three hours with a duration about 100 % . In some embodiments , the reduction in area of of no more than about three months , no more than about four bone marrow lesions represents an improvement relative to months , no more than about five months , or no more than placebo of at least about 10 % , at least about 20 % , at least 55 about six months. about 30 % , at least about 40 % , at least about 50 % , at least According to some embodiments , after the administration about 60 % , at least about 70 % , at least about 80 % , at least of an inhibitor of osteoclast activity , the area of bone marrow about 90 % , at least about 100 % , at least about 120 % , at least lesions relative to the size prior to administration remains about 150 % , at least about 170 % , at least about 200 % , at reduced for up to three months , four months , five months , least about 250 % , at least about 300 % , at least about 350 % , 60 six months, or even up to twelve months or more . According at least about 400 % , or at least about 450 % . In some to some embodiments , after the administration of an inhibi embodiments , the use of an inhibitor of osteoclast activity tor of osteoclast activity, the area of bone marrow lesions inhibits an increase in the size of bone marrow lesions over relative to the size prior to administration is reduced at about time. three months , at about four months, at about five months , at In some embodiments for patients having OARSI Grades 65 about six months, or at about twelve months. 1 - 2 or K / L Grades 2 - 4 JSN , the use of an inhibitor of According to some embodiments , after administration of osteoclast activity achieves a reduction in the total area of an inhibitor of osteoclast activity , the size of Modic changes US 10 ,016 , 446 B2 13 14 or VESCs relative to the size prior to administration remains hours , at least about 48 hours, at least about one week , at reduced for up to three months , four months , five months , least about 2 weeks , or at least about 3 weeks after admin six months, or even up to twelve months or more . According istration of an oral dosage form comprising zoledronic acid . to some embodiments , after the administration of an inhibi In some embodiments , a mammal, such as a human being, tor of osteoclast activity , the size of Modic changes or 5 experiences significant pain relief during at least part of the VESCs relative to the size prior to administration is reduced time from about 3 hours to about 2 weeks , about 3 hours to at about three months , at about four months , at about five about 3 weeks , about 3 hours to about 24 hours , about 6 months , at about six months , or at about twelve months . hours to about 2 weeks , or about 6 hours to about 24 hours , In some embodiments , an osteoclast inhibitor , such as a about 3 days to about 2 weeks, about 6 days to about 2 nitrogen - containing bisphosphonate , e . g . zoledronic acid , 10 weeks , after administration of an oral dosage form compris ibandronic acid or minodronic acid , may be administered to ing zoledronic acid . In some embodiments , a human being relieve complex regional pain syndrome, such as complex treated has significant pain relief at one month , three regional pain syndrome type I (CRPS - I ) , complex regional months, six months, nine months , one year, 5 years , or pain syndrome type II (CRPS -II ) , CRPS -NOS , or another longer , after administration of the most recent dose of an type of CRPS . 15 osteoclast inhibitor such as zoledronic acid . In some embodiments , zoledronic acid or another bispho With respect to the treatment of any condition recited sphonate may be administered orally to relieve complex herein , in some embodiments a first oral dosage form regional pain syndrome, such as complex regional pain comprising zoledronic acid is administered and a second syndrome type I (CRPS - I ) , complex regional pain syndrome oral dosage form comprising oral zoledronic acid is admin type II (CRPS - II ) , CRPS -NOS , or another type of CRPS . 20 istered . The timing of the administration of the two dosage CRPS is a type of inflammatory pain . CRPS can also have formsmay be such that, with respect to the first oral dosage a neuropathic component. form , the second oral dosage with respect to the first oral Complex regional pain syndrome is a debilitating pain dosage form , the second oral dosage form is administered at syndrome. It is characterized by severe pain in a limb that 5xTmax or greater ( e . g . , if Tmar is 1 hour, at 5 hours or later ) , can be accompanied by edema, and autonomic , motor and 25 at least 10xTmaxNax or greater , at least about 15xTmor or greater, sensory changes . at least about 20xTmor or greater, at least about 50xTmar or In some embodiments, an osteoclast inhibitor, such as a greater , or at least about 200xTmor or greater , wherein Tmoxmax nitrogen - containing bisphosphonate , e . g . zoledronic acid or is the time of maximum plasma concentration for the first minodronic acid , may be used to reduce the use of non - oral dosage form . steroidal anti - inflammatory drug (NSAIDs ) , opioids, or 30 Some embodiments include treatment of a condition other pain medications, for a patient suffering from pain , recited herein , such as inflammatory pain , arthritis , or com inflammation , a similar condition , or any condition plex regional pain syndrome, wherein the treatment com described herein . For example , use of NSAIDs, opioids , or prises either: administering only one dosage form to a other pain medications may be reduced by at least about 5 % , mammal to treat the condition , or administering a first at least about 10 % , at least about 15 % , at least about 20 % , 35 dosage form to the mammal, followed by administering a at least about 25 % , at least about 30 % , at least about 35 % , second dosage form to the mammal. If two or more dosage at least about 40 % , at least about 45 % , at least about 50 % , forms are administered , the second oral dosage form is at least about 60 % , at least about 70 % , at least about 80 % , administered before the maximum pain relieving effect of or at least about 90 % , up to about 100 % , as compared to the the first oral dosage form is achieved , or before a peak in the use of NSAIDs, opioids or other pain medications without 40 pain relieving effect of the first oral dosage form is experi administration of the osteoclast inhibitor. Use of the opioids, enced by a mammal, receiving the dosage form . In some NSAIDs, or other pain medications may be reduced by at embodiments , the second oral dosage form is administered least about 5 % , at least about 10 % , at least about 15 % , at before an observable pain relieving effect is achieved . In least about 20 % , at least about 25 % , at least about 30 % , at some embodiments , the second dosage form is administered least about 35 % , at least about 40 % , at least about 45 % , at 45 about 12 hours to about 60 days , about 24 hours to about 28 least about 50 % , at least about 60 % , at least about 70 % , at days , about 24 hours to about 7 days , about 24 hours to about least about 80 % , or at least about 90 % , up to about 100 % , 14 days , or about 24 hours to about 21 days , after the first as compared to the use of NSAIDS, opioids, or other pain dosage form is administered . medications at baseline . Some embodiments include treatment of a condition The reduction in the use of NSAIDs , opioids, or other pain 50 recited herein , such as inflammatory pain , arthritis , or com medications may be observed at about one week , about two plex regional pain syndrome, wherein the treatment com weeks, about three weeks , about one month , about two prises administering a first dosage form to the mammal, months , about three months, about four months , about five followed by administering a second dosage form to the months, about six months, about seven months, about eight mammal, wherein the second dosage form is administered months , about nine months, about 10 months , about 11 55 after the maximum pain relieving effect of the first oral months, or about one year or more , after the administration dosage form is achieved , and the second oral dosage form is of osteoclast inhibitor. administered while the mammal is still experiencing pain With respect to use of oral zoledronic acid in a disodium relief from the first oral dosage form , or while the pain salt form or in an acid form for relieving pain associated relieving effect from the first oral dosage form is observable . with an inflammatory condition or Paget ' s disease of bone , 60 In some embodiments , the second dosage form is adminis relief of pain can be short - term , e . g . for a period of hours tered about 12 hours to about 60 days , about 24 hours to after administration of the dosage form , and /or relief of pain about 28 days, about 24 hours to about 7 days, about 24 can be long - term , e . g . lasting for days, weeks, or even hours to about 14 days , or about 24 hours to about 21 days , months after oral administration of zoledronic acid . In some after the first dosage form is administered embodiments, a mammal, such as a human being , experi- 65 Zoledronic acid or another bisphosphonate may also be ences significant pain relief at least about 3 hours , at least administered orally to relieve cancer - related pain , including about 6 hours , at least about 12 hours , at least about 24 pain associated with multiple myeloma and bone metastases US 10 ,016 , 446 B2 15 from solid tumors. In some embodiments , zoledronic acid is used to treat pain that is not cancer- related pain . For Formula A example , zoledronic acid may be used to treat pain that is not R R2 associated with multiple myeloma, bone metastasis from O== solid tumors , hypercalcemia of malignancy , giant cell tumor 5 of bone, blood cancers or leukemias, or solid tumors or HO ' ud OH cancers. In some embodiments , enhanced bioavailability of ?? ?? the zoledronic acid may be achieved in treating one of these conditions by administering a dosage form comprising zole With respect to Formula A , R is F , C1, Br, H , or OH . In dronic acid in the form of a disodium salt . This may allow some embodiments , R is OH . a reduced molar amount of the disodium salt to be used as With respect to Formula A , R² is aminoalkyl, such as compared to what would be used with the diacid form . aminoethyl , aminopropyl, aminopentyl, dimethylamino In addition to relieving pain , oral administration of zole - ethyl, methylpentylaminoethyl , etc ; or optionally substituted dronic acid or another bisphosphonate may also be useful to 15 heterocyclyl alkyl, such as optionally substituted imida treat diseases or conditions that may or may not include a zolylmethyl , optionally substituted pyridinymethyl , etc . In pain component. For example , zoledronic acid or another some embodiments R2 is optionally substituted imidazoly bisphosphonate may be useful to treat any of the pain lalkyl. conditions or types of conditions listed above , including Unless otherwise indicated , when a compound or chemi treatment that does not simply relieve the pain of those 20 cal structural feature such as heterocyclyl alkyl is referred to conditions , and treatment that is carried out in such a way as being “ optionally substituted, ” it includes a feature that that the condition is treated without pain relief occurring . In has no substituents ( i .e . unsubstituted ), or a feature that is addition to any pain relief zoledronic acid or another bis substituted , meaning that the feature has one or more sub phosphonate may or may not provide, zoledronic acid or 25 stituents . The term " substituent” has the broadest meaning another bisphosphonate may be used to treat a disease or known to one of ordinary skill in the art , and includes a condition such as a metabolic disease or condition ; an moiety that replaces one or more hydrogen atoms in a parent inflammatory disease or condition , including an inflamma compound or structural feature . The term “ replaces” is tory disease or condition that is not associated with pain ; a merely used herein for convenience , and does not require cancer disease or condition ; a neurological disease or con - 303 that the compound be formed by replacing one atom with dition , etc . In some embodiments , enhanced bioavailability another . In some embodiments , a substituent may be any of the zoledronic acid may be achieved in treating one of ordinary organic moiety known in the art, which may have these conditions by administering a dosage form comprising a molecular weight ( e . g . the sum of the atomic masses of the zoledronic acid in the form of a disodium salt . This may atoms of the substituent) of 15 g /mol to 50 g /mol , 15 g /mol allow a reduced molar amount of the disodium salt to be 35 to 100 g /mol , 15 g/ mol to 150 g/ mol , 15 g/ mol to 200 g /mol , used as compared to what would be used with the diacid 15 g /mol to 300 g /mol , or 15 g / mol to 500 g /mol . In some form . embodiments , a substituent comprises , or consists of: 0 - 30 , In some embodiments , oral administration of zoledronic 0 - 20 , 0 - 10 , or 0 - 5 carbon atoms; and 0 - 30 , 0 - 20 , 0 - 10 , or 0 - 5 acid or another bisphosphonate may also be useful to treat heteroatoms, wherein each heteroatom may independently complex regional pain syndrome, rheumatoid arthritis , * be : N , O , P , S , Si, F , C1, Br, or I ; provided that the substituent osteoarthritis , erosive osteoarthritis , axial spondyloarthritis includes one C , N , O , P , S , Si, F , C1, Br, or I atom . In some including ankylosing spondylitis , acute vertebral crush frac - embodiments , substituents can independently have a ture, fibrous dysplasia , SAPHO syndrome, osteoporosis , molecular weight of about 15 Da to about 600 Da and can transient osteoporosis , or transient osteoporosis of the hip . In 45 consist of 2 to 5 chemical elements, wherein the chemical some embodiments , enhanced bioavailability of the zole - elements are independently C , H , O , N , P , S , Si, F , C1, or Br. dronic acid may be achieved in treating one of these con - In some embodiments , a substituent is optionally substituted ditions by administering a dosage form comprising zole alkyl , O -alkyl (e . g . — OCH3, OC2H5 , - OC3H7, dronic acid in the form of a disodium salt . This may allow OC _ H , etc .) , - S -alkyl (e . g. - SCH , SC , H , a reduced molar amount of the disodium salt to be used as 50 — SC H ,, - SC . H . , etc . ) , — NR ' R " , - OH , — SH , — CN , compared to what would be used with the diacid form . CF3, — NO , , perfluoroalkyl , optionally substituted aryl , In some embodiments , oral administration of zoledronic optionally substituted heteroaryl, optionally substituted acid or another bisphosphonate may also be useful to treat amine or a halogen , wherein R ' and R " are independently H hypercalcemia of malignancy , multiple myeloma, bone or optionally substituted alkyl. Wherever a substituent is metastases from solid tumors , Paget' s disease ofbone , giant 55 described as “ optionally substituted, ” that substituent can be cell tumor of bone , blood cancers or leukemias , or solid substituted with the above substituents . For convenience, the term " molecular weight” is used tumors or cancers . In some embodiments , enhanced bio with respect to a moiety or part of a molecule to indicate the availability of the zoledronic acid may be achieved in 60 sum of the atomic masses of the atoms in the moiety or part treating one of these conditions by administering a dosage 60 of a molecule , even though it may not be a complete form comprising zoledronic acid in the form of a disodium molecule . salt . This may allow a reduced molar amount of the diso Examples of nitrogen -containing bisphosphonates dium salt to be used as compared to what would be used with include but are not limited to pamidronic acid , incadronic the diacid form . 65 acid , ibandronic acid , risedronic acid , minodronic acid , Some nitrogen -containing bisphosphonates may be rep - cimadronic acid , neridronic acid , alendronic acid , olpad resented by Formula A : ronic acid , zoledronic acid , etc . US 10 ,016 ,446 B2 17

OH HOWNH OH HO OH HYLOH ON 07 HOODHO OH pamidronic acid Zoledronic acid 10 Unless otherwise indicated , any reference to a compound - NH herein , such as zoledronic acid , by structure , name, or any P - OH other means, includes pharmaceutically acceptable salts , O = such as the disodium salt ; alternate solid forms, such as OH polymorphs, solvates, hydrates, etc .; tautomers ; or any other HO OOH chemical species that may rapidly convert to a compound incadronic acid described herein under conditions in which the compounds are used as described herein . Unless otherwise indicated , a phrase such as " administering a bisphosphonate , " " admin 20 istering an osteoclast inhibitor, " " administering zoledronic acid ,” includes administering any form of the bisphospho nate , osteoclast inhibitor , zoledronic acid , etc . , such as those recited above . In some embodiments , zoledronic acid is administered in 25 a dosage form comprising a salt form , such as a salt of a dianion of zoledronic acid . In some embodiments , zole dronic acid is administered in a dosage form comprising a HO OH disodium salt form of zoledronic acid . In some embodi 10 OH ments , zoledronic acid is administered in a sodium salt form , POH 30 such as a monosodium salt, a disodium salt , a trisodium salt, ? HO — P = O etc . In some circumstances , use of the disodium salt may be desirable . For example , the disodium salt is much more HO soluble in water than the diacid form . As a result , in some ibandronic acid processes , the disodium salt can be easier to work with than 35 the diacid form . Additionally , the sodium salt may be more bioavailable and /or more rapidly absorbed when taken orally as compared to the diacid form . o=4–3,0 ?? In some embodiments , a RANK / RANKL antagonists or HOOH an osteoclast inhibitor, such as zoledronic acid or neridronic HO 40 acid may be in the form of a molecular complex . For example , molecular complexes of zoledronic acid include risedronic acid cocrystals , salts , solvates such as hydrates and mixed sol vates of an acid or a salt form , and mixtures containing such materials. Molecular complexes of zoledronic acid may be HO ?????? 45 in amorphous forms or polymorphs . OH OH Of particular interest are compositions , or complexes HN . comprising zoledronic acid or neridronic acid and the stan dard amino acids or natural existing amino acids, such as alanine , arginine , asparagine , aspartic acid , cysteine , gluta 50 mic acid , glutamine, glycine, histidine, isoleucine, leucine , lysine , methionine , phenylalanine , proline , serine , threonine , cimadronic acid tryptophan , tyrosine, valine , etc . Some examples of useful molecular complexes include , but are not limited to , com plexes of zoledronic acid or neridronic acid with sodium 55 cation , ammonium , ammonia , L - lysine , DL - lysine, nicoti namide , adenine , glycine, and Selenocysteine . Zoledronic acid may also be in a form represented by one of the structural depictions below . HO P = 0 HO NH3 HOOH 10 -H - O H " minodronic acid HNYLP: 65 Zoledronic acid has the structure shown below , and is also NH3+ referred to as zoledronate. US 10 ,016 ,446 B2 19 20 -continued -continued HO O - - -HO ] NH3+ POzHPOH ++ HNHNS V " 1110 / PO3H2 HOONHO ! la OH PO3H M Zoledronic acid in a salt or an acid form may be present PO3H in a molecular complex having strong X -ray powder dif OH fraction peaks in one of the following positions : Hla strong X - ray powder diffraction peaks Form (°20 0 . 2 ) zoledronic acid , sodium zoledronate and about 8 . 1 , about 13 . 3 , about 21. 5 , about water complex 24 . 6 , and about 25 . 6 ammonium zoledronate salt and water about 11. 0 , about 14 . 6 , about 15 . 4 , corcomplex about 19 . 9 , and about 29 . 4 zoledronic acid , L - lysine , and water about 9 . 0 , about 14 . 4 , about 18 . 1 , about complex 26 . 0 , and about 29 . 6 zoledronic acid , DL - lysine , and water about 9 . 1 , about 14 . 7 , about 18. 0 , about complex 21 . 2 , and about 26 . 0 zoledronic acid , DL- lysine, ethanol, and about 8 . 8 , about 9 . 7 , about 17 . 6 , about water complex 23. 1 , and about 26 . 5 zoledronic acid , nicotinamide, and water 13 . 1 , about 15. 2 , about 21. 0 , about 23 . 9 , complex and about 26 . 5 zoledronic acid , adenine, and water about 13. 6 , about 15 . 9 , about 19 . 7 , complex about 27 . 9 , and about 29. 5 zoledronic acid and glycine complex about 10 . 2 , about 17 . 8 , about 19 . 9 , about 22 . 9 , and about 28 . 1 zoledronic acid diammonia , and water about 12 . 2 , about 13 . 0 , about 14 . 1 , complex about 17 . 1 , and about 19 . 3 zoledronic acid , DL - lysine , and water about 8 . 3 , about 11 . 8 , about 12 . 3 , about complex 15 . 8 , and about 20 . 8 zoledronic acid , L - lysine , and water about 9 . 6 , about 10 . 7 , about 14 . 3 , about complex 21 . 4 , and about 23 . 5 zoledronic acid , DL - lysine , and water about 9 . 7 , about 10 . 8 , about 14 . 4 , about complex 18 . 9 , and about 21. 4 zoledronic acid , DL - lysine complex 7 . 2 , about 14 . 0 , about 18 . 3 , about 19 . 1 , about 20 . 7 , about 24 . 6 , and about 34 . 4 zoledronic acid , DL - lysine complex 6 . 6 , about 11 . 0 , about 14 . 2 , about 18 . 3 , about 19 . 7 , about 22. 7 , and about 27 . 6

40 Solid forms of zoledronic acid such as complexes of -continued zoledronic acid with sodium , ammonium , ammonia , L - ly 2M + sine, DL - lysine , nicotinamide , adenine and glycine may be POH prepared by methods such as dry or solvent- drop grinding IPOH ( liquid assisted grinding ) , heating or solvent evaporation of 45 * their solution in single or mixed solvent systems, slurry OH suspension , supercritical fluids or other techniques known to Lab 4M + PO32 - 4M + a person skilled in the art . For example , zoledronic acid and nicotinamide may be PO32 complexed by dissolving both compounds in water: ethyl 50 - 0 acetate ( 1 : 1 v / v ) and allowing the solvents in the mixture to OH evaporate to form crystalline material. Hea In some embodiments , a zoledronic acid complex may have an excess at least one coformer ( e . g . the component wherein X is any suitable anion , e . g . F - , Br - , Cl- , I - , OH ” , other than zoledronic acid ) to the zoledronic acid complexes , acetate , etc . ; and M * is any suitable cation , e . g . Na + , K + , which may be the same as the coformer in the complex , 355a NH4 +, etc . Many other salt forms are also possible . different coformer , or a mixture thereof . In some embodi In some embodiments , a compound containing Ion 1 may ments , the excess coformer may be a standard or natural be further represented by a formula , amino acid . Examples of compounds in salt forms contain ing Ion 1 are shown below : 60 PO3Na2

7x PO3Na2 . PO3H2 ia ?? Nato PO3H2 65 OH In some embodiments , a compound containing Ion 1 may Lia be in a hydrate form . US 10 , 016 , 446 B2 22 In some embodiments , a compound containing Ion 1 is In some embodiments , a compound containing Ion 2 may administered in a dosage form comprising a salt form , such be in a hydrate form . as a zwitterionic form , or a salt of a cation , a monoanion , a In some embodiments , a compound containing Ion 2 is dianion , a trianion , etc . administered in a dosage form comprising a salt form , such A compound containing Ion 1 can be present in any 5 as a zwitterionic form , or a salt of a cation , a monoanion , a amount, such as less than about 100 % w / w , less than about dianion , a trianion , etc . 50 % w / w , less than about 20 % w / w , less than about 10 % A compound containing Ion 2 can be present in any w / w , less than about 1 % w / w , less than 0 . 1 % w / w , less than amount, such as less than about 100 % w / w , less than about 50 % w / w , less than about 20 % w / w , less than about 10 % about 0 . 07 % w / w , less than about 0 .05 % w / w , less than 10 w / w , less than about 1 % w / w , less than about 0 . 3 % , less than about 0 .04 % w / w , less than about 0 .03 % w / w , less than about 0 . 2 % , less than 0 . 1 % w / w , less than about 0 .08 % w / w , about 0 .02 % w / w ; and /or greater than 0 % w / w , at least about less than about 0 .07 % w / w , less than about 0 .05 % w /w , less 0 .00000001 % w / w , at least about 0 .000001 % w / w , or at least than about 0 .04 % w /w , less than about 0 . 03 % w / w , less than about 0 .00001 % w / w , based upon the total amount of about 0 .02 % w / w ; and / or greater than 0 % w / w , at least about zoledronic acid , a compound containing Ion 1 , and a comW 15 0 . 00000001 % w / w , at least about 0 .000001 % w / w , or at least pound containing Ion 2 present in the composition . about 0 .00001 % w / w , based upon the total amount of Examples of salts of compounds containing Ion 2 are zoledronic acid , a compound containing Ion 1 , and a com shown below : pound containing Ion 2 present in the composition . In some embodiments , a compound containing Ion 1 and 20 a compound containing Ion 2 are present in an amount that PO3H2 1 is less than 0 . 1 % w / w . PO3H2 In some embodiments , the administration of an osteoclast PO3H2 inhibitor, such as a nitrogen - containing bisphosphonate , HO Nite OH including , e . g . zoledronic acid , minodronic acid , etc . , to a PO3H2 25 patient or mammal in need thereof affects Modic changes PO H (MCs ) . For example , any of the above compounds could be PO3H2 used to treat Modic changes, or vertebral endplate signal PO3H2 changes (VESC ) and bone marrow changes visible using HO VNEN ?? magnetic resonance imaging (MRI ) , or neck pain or back PO3H2 30 pain associated with Modic changes . POH M + Modic changes , as used herein , includes its ordinary PO3H meaning in the art and refers to pathological vertebral endplate and bone marrow changes visible using magnetic PO3H resonance imaging (MRI ) . Modic changes may also be HO PO3H2 ?? 35 referred to as vertebral endplate signal changes (VESC ) . Modic changes , can be classified into various types includ PO3H 2M + ing type 1 (M1 ), type 2 (M2 ) , and type 3 (M3 ) lesions or fortPO3H changes, any of which may be treated using an osteoclast NA PO3H inhibitor, such as a nitrogen - bisphosphonate , including , e . g . HO Vio OH 40 zoledronic acid , minodronic acid , etc . Different types of PO3H2 Modic changes may occur in the same patient, for example PO3H 4M + type 1 and type 2 Modic changes (M1 / 2 ) . In some cases, M1 PO3H changes are related to lower back pain than other types of PO3H Modic change . HO OH 45 VESCs may be found in patients with different types of PO3H low back pain including but not limited to spondylitis , PO3H " 4Na + trauma, spondyloarthropathies including ankylosing spon fariPO3H - OH dylitis , Schmorl ' s nodes , fracture , tumor, and spinal cord PO3H infarction . Lesions in ankylosing spondylitis include osteitis ?? 50 and spondylodiscitis, which can be detected using MRI or POH another medical imaging instrument. cari Modic changes may be found in the cervical , thoracic , lumbar , and sacral spine . Modic changes may be found at wherein X is any suitable anion , e . g . F - , Br , 01- , I - , OH ” , various spinal levels such as at C1/ 2 , C2 /3 , C3 /4 , C4 /5 , acetate , etc .; and M * is any suitable cation , e . g . Na + , K + , 55 C5 /6 , C6 / 7 , C7 / T1 . T1/ 2 . T2 / 3 , T3 / 4 , T4 / 5 , T5 /6 , 76 / 7 , 17 / 8 , NH4+ , etc . Many other salt forms are also possible . T8 / 9, T9 / 10 , T10 / 11, T11/ 12 , T12 /L1 , L1 /2 , L2 /3 , L3 / 4 , In some embodiments , a salt of a compound containing L4 / 5 , L5/ S1 , etc ., any of which may be treated using an Ion 2 may be further represented by a formula , osteoclast inhibitor, such as a nitrogen - bisphosphonate , including, e . g . zoledronic acid , minodronic acid , etc . PO3HNa 60 In some embodiments , the Modic change being treated is PO3HNa located at L2 / 3 . In some embodiments , the Modic change being treated is located at L3 / 4 . In some embodiments, the PO3HNa Modic change being treated is located at L4/ 5 . In some HO Nome OH PO3HNa embodiments , the Modic change being treated is located at Na 65 L5/ S1. OOH In some embodiments , the Modic change being treated is located at C3/ 4 . In some embodiments , the Modic change US 10 ,016 ,446 B2 23 24 being treated is located in at C4 / 5 . In some embodiments , the at least about 70 % at least about 80 % , at least about 90 % , or Modic change being treated is located in at C5 /6 . In some about 100 % . In some embodiments , the reduction the size of embodiments , the Modic change being treated is located in Modic changes or VESCs represents an improvement rela at C6 / 7 . tive to placebo of at least about 10 % , at least about 15 % , at In some embodiments , the Modic change being treated is 5 least about 20 % , at least about 25 % , at least about 30 % , at located at T5 / 6 . In some embodiments, the Modic change least about 40 % , at least about 50 % , at least about 60 % , at being treated is located in at T6 / 7 . In some embodiments , the least about 70 % , at least about 80 % , at least about 90 % , at Modic change being treated is located in at T7 / 8 . In some least about 100 % , at least about 120 % , at least about 150 % , embodiments , the Modic change being treated is located in at least about 170 % , at least about 200 % , at least about at T8 / 9 . In some embodiments , the Modic change being 10 250 % , at least about 300 % , at least about 350 % , at least treated is located at T9 / 10 . about 400 % , or at least about 450 % . In some embodiments , In some embodiments , the patient being treated has pre - the use of an inhibitor of osteoclast activity inhibits an dominantly Mi. In some embodiments , the patient being increase in the size of Modic changes or VESCs over time. treated has predominantly M1/M2 . In some embodiments. The oral bioavailability of zoledronic acid may be the patient being treated has predominantly M2. In some 15 enhanced by orally administering the zoledronic acid in the embodiments , the patient being treated has predominantly disodium salt form . For example, the bioavailability of M3. zoledronic acid may be improved by at least about 10 % , at In some embodiments , the worst type of lesion that the least about 20 % , at least about 30 % , at least about 50 % , patient being treated has is M1. In some embodiments , the and / or up to about 100 % , or up to about 200 % , as compared worst type of lesion that the patient being treated has is 20 to administration of zoledronic acid in the diacid form . M1/ 2 . In some embodiments , the worst type of lesion that Because of the improved bioavailability of the disodium the patient being treated has is M2 . salt a dosage form may contain , or a mammal, such as a In some embodiments , the patient being treated has human being , may receive , on a molar basis , less of the Modic changes at more two or more levels . In some embodi- disodium salt form of zoledronic acid than would otherwise ments the patient being treated has Modic changes at three 25 de administered of the diacid form of zoledronic acid . For or more levels . In some embodiments greater pain relief is example , a dosage form may contain , or a mammal may obtained when treating a patient with Modic changes at two receive, at least about 10 mole % less, at least about 20 mole levels , or three or more levels , than is obtained when treating % less , at least about 40 mole % less , at least about 50 mole a patient with Modic changes at a single level or at two % less, and / or up to about 90 mole % less or 95 mole % less , levels. 30 of the disodium salt form as compared the amount of the In some embodiments greater pain relief is obtained when diacid form of zoledronic acid that would otherwise be treating a patient with Modic changes at two levels than is administered , such as a molar amount that would be admin obtained when treating a patient with Modic changes at a istered of zoledronic acid in the diacid form in order to single level. achieve the same plasma levels of zoledronic acid . In some embodiments greater pain relief is obtained when 35 In some embodiments , a dosage form contains , or a treating a patient with Modic changes at three or more levels mammal ( such as a human being ) is administered , an than is obtained when treating a patient with Modic changes amount of the disodium salt form , on a molar basis , that has at a single level. a value of about 0 . 8n , to about 1 .2n ; or about 0 . 9n , to about In some embodiments greater pain relief is obtained when 1 . 1nd, wherein : treating a patient with Modic changes three or more levels 40 than is obtained when treating a patient with Modic changes =( b _ ba) ( .) at two levels . wherein b , is the bioavailability of the diacid form , b is the In some embodiments, the inhibitor of osteoclast activity bioavailability of the disodium salt form , and n , is the may be used to effect a reduction in the levels of pro - number ofmoles of the diacid that would be administered in inflammatory cytokines in the patient with low back pain or 45 a dosage form containing the diacid form of zoledronic acid . any other type of pain or condition recited herein . In some For example , if the diacid form has a bioavailability ( b ) of embodiments greater pain relief may be obtained in patients 0 .01 and the disodium salt form has a bioavailability (bg ) of with greater baseline levels of pro - inflammatory cytokines 0 .015 , and a dosage form would normally contain 0 . 001 when treated with an inhibitor of osteoclast activity, such as moles of the diacid , n , would be ( 0 . 01 / 0 .015 ) ( 0 .001 moles ) , a nitrogen - containing bisphosphonate , including e . g . zole - 50 or about 0 . 00067 moles . In some embodiments , the diso dronic acid , minodronic acid , etc . In some embodiments, dium salt is administered in an amount that has a value of greater pain relief may be obtained in patients who experi- about nj. ence a reduction or a greater reduction in the levels of With respect to oral dosage forms comprising a reduced pro - inflammatory cytokines when treated with an inhibitor molar amount of the disodium salt of zoledronic acid as of osteoclast activity , such as a nitrogen -containing bispho - 55 compared to the diacid form of zoledronic acid , in some sphonate , including e . g . zoledronic acid , minodronic acid , embodiments , the bioavailability of the zoledronic acid in etc . Pro - inflammatory cytokines include but are not limited the disodium salt form is sufficiently high that , if the drug is to IL - 1 , IL - 2 , IL - 3 , IL - 6 , IL - 8 , IL - 10 , IL - 12 , tumor necrosis administered to a mammal, at least as much zoledronic acid alpha ( TNF -alpha ), interferon gamma, etc . is present in the blood of the mammal as would be present In some embodiments , the use of an inhibitor of osteoclast 60 if zoledronic acid were administered in the diacid form . activity , such as a nitrogen - containing bisphosphonate , With respect to oral dosage forms comprising the diso including e . g . zoledronic acid , minodronic acid , etc . , to a dium salt form of zoledronic acid , in some embodiments , the patient or mammal in need thereof, achieves a reduction disodium salt form is present in a lower molar amount than relative to baseline in the size of Modic changes or VESCs would be present if the zoledronic acid were in the diacid of at least about 5 % , at least about 10 % , at least about 15 % , 65 form ; and the zoledronic acid in the disodium salt form has at least about 20 % , at least about 25 % , at least about 30 % , an improved bioavailability as compared to the zoledronic at least about 40 % , at least about 50 % , at least about 60 % , acid in the diacid form to the extent that the lower molar US 10 , 016 , 446 B2 25 26 amount of the disodium salt in the dosage form does not form is administered . This amount may be suitable for reduce the amount of zoledronic acid delivered to the plasma administration of the oral dosage form about every 3 to 4 of a mammal. weeks. Some oral dosage forms comprising zoledronic acid have In some embodiments , the zoledronic acid , such as zole a dose of zoledronic acid and a configuration suitable for a 5 dronic acid in an acid form or a salt form , such as the particular species of mammal, e . g . dog, rat , human , etc . Such disodium salt form , is present in an amount such that the oral a dosage form may have zoledronic acid present in an dosage form provides an area under the plasma concentra amount that results in a desired range for an area under the tion curve ( AUC ) of zoledronic acid of about 20 ng - h /mL to plasma concentration curve ( AUC ) of zoledronic acid in that about 700 ng . h /mL , about 50 ng . h /mL to about 500 ng h /mL , particular species of mammal. For example the dose of 10 about 50 ng . h /mL to about 400 ng . h /mL , about 50 ng - h /mL zoledronic acid and a configuration of the oral dosage form to about 300 ng h /mL , about 50 ng - h /mL to about 200 may result in an AUC of zoledronic acid of about 1 ng - h /mL ng - h /mL , about 50 ng -h /mL to about 100 ng h /mL , about 130 to about 700 ng. h /mL , about 3 ng h /mL to about 30 ng. h /mL , ng - h /mL to about 150 ng - h /mL , about 130 ng - h /mL to about about 3 ng. h /mL to about 10 ng h /mL , about 50 ng - h /mL to 140 ng - h /mL , about 150 ng .h /mL to about 200 ng h /mL , about 700 ng . h /mL , about 130 ng . h /mL to about 180 ng. h / 15 about 200 ng. h /mL to about 300 ng . h /mL , about 250 ng . h / mL , about 300 ng - h /mL to about 450 ng - h /mL , about 300 mL to about 300 ng. h /mL , about 300 ng - h /mL to about 400 ng .h /mL to about 350 ng- h /mL , about 300 ng- h /mL to about ng .h /mL , about 400 ng. h /mL to about 500 ng .h /mL , about 310 ng: h /mL , about 340 ng -h /mL to about 350 ng. h /mL , 350 ng- h /mL to about 400 ng: h /mL , about 450 ng- h /mL to about 370 ng . h /mL to about 420 ng - h /mL , about 380 ngh a bout 500 ng. h /mL , about 130 ng h /mL to about 160 ng . h / mL to about 390 ng- h /mL , about 405 ng. h /mL to about 415 20 mL , about 405 ng - h /mL to about 450 ng .h /mL , about 100 ng . h /mL , about 140 ng . h /mL to about 160 ng - h /mL , about ng h /mL to about 500 ng h /mL , about 100 ng . h /mL to about 140 ng. h /mL to about 150 ng h / mL , about 150 ng - h /mL to 400 ng - h / mL , about 100 ng - h /mL to about 300 ng - h /mL , about 160 ng- h /mL , about 140 ng- h /mL , 142 ng h /mL , about about 100 ng- h /mL to about 200 ng- h /mL , about 125 ng. h / 155 ng h /mL , about 305 ng . h /mL , 304 ng - h /mL , about 345 mL to about 500 ng . h /mL , about 125 ng - h /mL to about 400 ng- h /mL , 343 ng h /mL , about 385 ng -h /mL , 384 ng- h /mL , 25 ng h /mL , about 125 ng h /mL to about 300 ng- h /mL , about about 410 ng: h /mL , or any AUC in a range bounded by, or 125 ng - h /mL to about 200 ng. h /mL , or about 200 ng - h /mL between , any of these values , upon administration of the oral to about 300 ng h /mL , in the mammal to which the dosage dosage form to a mammal. form is administered . This amount may be suitable for Unless otherwise indicated , the AUC refers to the AUC weekly administration of the oral dosage, or for administra calculated to the last measured concentration (AUCO . , and 30 tion of 3 to 5 individual dosages during a month . The extrapolated to infinity ( AUC ( O- ing ) . individual dosages could be given at regular intervals , given An oral dosage form comprising zoledronic acid having a during the first week , or at any other schedule that provides dose of zoledronic acid and a configuration suitable for a 3 to 5 dosages during the month . particular species of mammal may have zoledronic acid In some embodiments , the zoledronic acid is present in an present in an amount that results in a Cmor of zoledronic acid 35 amount such that the oral dosage form provides an area of about 0 . 2 ng /mL to about 300 ng /mL , about 0 .5 ng /mL to under the plasma concentration curve of zoledronic acid of about 5 ng/ mL , about 5 ng /mL to about 300 ng /mL , about 5 about 4 ng - h /mL to about 100 ng. h /mL , about 10 ng -h /mL to ng /mL to about 50 ng /mL , about 20 ng /mL to about 50 about 50 ng h /mL , about 10 ng - h /mL to about 30 ng h / mL , ng /mL , about 30 ng /mL to about 50 ng /mL , about 50 ng /mL 20 ng - h /mL to about 700 ng h /mL , about 50 ng . h /mL to to about 200 ng /mL , about 50 ng /mL to about 150 ng /mL , 40 about 500 ng - h /mL , about 50 ng h /mL to about 400 ng h /mL , about 80 ng/ mL to about 120 ng /mL , about 90 ng /mL to about 50 ng . h /mL to about 300 ng .h /mL , about 50 ng - h /mL about 100 ng/ mL , about 50 ng/ mL to about 200 ng /mL , to about 200 ng - h /mL , about 100 ng. h /mL to about 500 about 40 ng /mL , about 95 ng /mL , about 97 ng /mL , or any ng: h /mL , about 100 ng -h /mL to about 400 ng - h /ml , about Cmax in a range bounded by, or between , any of these values , 100 ng h /mL to about 300 ng. h /mL , about 100 ng - h / mL to upon administration of the oral dosage form to a mammal. 45 about 200 ng- h /mL , about 125 ng h /mL to about 500 ng -h / An oral dosage form comprising zoledronic acid having a mL , about 125 ng .h /mL to about 400 ng .h /mL , about 125 dose of zoledronic acid and a configuration suitable for a ng. h /mL to about 300 ng - h/ mL , about 125 ng- h /mL to about particular species of mammal may be configured so that 200 ng - h /mL , or about 200 ng h /mL to about 300 ng - h /mL administration of the oral dosage form to the particular in the mammal to which the dosage form is administered . species of mammal results in a Tmax of zoledronic acid of 50 This amount may be suitable for daily administration of the about 0 . 4 hr to about 1 hr, about 0 . 5 hr, or about 0 .75 hr, or oral dosage form . In some embodiments , the dosage form any Tmax in a range bounded by, or between , any of these may be administered for 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , or 10 , 5 to 10 , values . or 6 to 10 consecutive days . In some embodiments , the zoledronic acid in the diso . In some embodiments , the zoledronic acid , such as zole dium salt form is present in an amount such that the oral 55 dronic acid in an acid form or a salt form , such as the dosage form provides an area under the plasma concentra - disodium salt form , is present in an amount such that the oral tion curve of zoledronic acid of about 4 ng- h /mL to about administration of the dosage form in a fasted state results in 2000 ng . h /mL to the mammal each time the zoledronic acid an area under the plasma concentration curve (AUC ) of in the disodium salt is administered . zoledronic acid of about 50 ng- h /mL to about 500 ng- h /mL , In some embodiments, the zoledronic acid , including 60 about 50 ng. h / mL to about 100 ng - h /mL , about 100 ng. h /mL zoledronic acid in an acid or a salt form , e . g the disodium to about 200 ng - h / mL , about 130 ng h /mL to about 180 salt form , is present in an amount such that the oral dosage ng. h /mL , about 130 ng -h /mL to about 150 ng - h /ml , about form provides an area under the plasma concentration curve 130 ng h /mL to about 140 ng h /mL , about 140 ng . h /mL to of zoledronic acid of about 100 ng -h /mL to about 2000 about 150 ng. h /mL , about 150 ng -h /mL to about 200 ng -h / ng - h /mL , about 100 ng . h /mL to about 1000 ng - h /mL , about 65 mL , about 200 ng - h /mL to about 300 ng - h /ml , about 250 500 ng . h /mL to about 1000 ng . h /mL , or about 500 ng . h /mL ng - h /mL to about 300 ng h /mL , about 300 ng . h /mL to about to about 700 ng h /mL in the mammal to which the dosage 400 ng -h /mL , about 300 ng -h /mL to about 350 ng -h /mL , US 10 , 016 , 446 B2 28 about 400 ng- h /mL to about 500 ng- h /mL , about 350 ng - h / An oral dosage form comprising zoledronic acid having a mL to about 400 ng h /mL , about 450 ng- h /mL to about 500 dose of zoledronic acid and a configuration suitable for a ng - h /mL , about 130 ng - h /mL to about 160 ng - h /mL , about particular species of mammal may be configured so that the 405 ng. h /mL to about 450 ng h /mL , measured over a 24 hour zoledronic acid has a 12 hour sustained plasma level factor period . 5 of about 12 to about 50 , about 20 to about 40 , about 25 to In some embodiments , molecular complex comprising about 30 , about 30 to about 35 , about 35 to about 40 , about 33 , about 30 , about 35 , or any 12 hour sustained plasma level neridronic acid is administered in an amount that results in factor in a range bounded by , or between , any of these an AUC of neridronic acid , measured over the entire course values , for the particular species of mammal. of treatment, of about 10 , 000 - 30 , 000 ng h /mL about 30 , 000. 10 An oral dosage form comprising zoledronic acid having a 100 ,000 ng h /mL about 30 ,000 - 50 ,000 ng . h /mL , about 10 dose of zoledronic acid and a configuration suitable for a 30 , 000 -40 ,000 ng . h /mL , about 40 , 000 - 50 , 000 ng. h /mL , particular species ofmammal may be configured so that the about 50 ,000 -60 , 000 ng . h /mL , about 60 ,000 - 70 , 000 ng . h / zoledronic acid has a 24 hour sustained plasma level factor mL , about 50 , 000 -70 ,000 ng. h / mL , about 70 , 000 - 80 , 000 of about 10 to about 30 , about 10 to about 20 , about 10 to ng - h /mL , about 80 , 000 - 90 ,000 ng h /mL , about 90 ,000 - 100 , 15 about 15 , about 12 to about 15 or 16 , about 15 to about 20 , 000 ng - h / mL , about 70 ,000 - 100 , 000 ng . h /mL , about 100 , about 14 , about 12 , about 15 , or any 24 hour sustained 000 - 200 , 0000 ng- h /mL , about 200 , 000 - 300 , 0000 ng . h /mL , plasma level factor in a range bounded by , or between , any about 300 , 000 -400 ,0000 ng h /mL , about 400 , 000 -500 ,0000 of these values, for the particular species of mammal. ng - h /mL , or any AUC in a range bounded by any of these An oral dosage form comprising zoledronic acid having a values . 20 dose of zoledronic acid and a configuration suitable for a In some embodiments , an osteoclast inhibitor , a bispho particular species ofmammal may be configured so that the sphonate , or a RANK /RANKL antagonist , such as zole zoledronic acid has a 36 hour sustained plasma level factor dronic acid , etc ., is administered at an interval of aboutonce , of about 6 to about 20 , about 8 to about 15 , about 9 to about twice, or thrice daily , or every 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 or 13 , about 8 to about 10 , about 11 to about 13 , about 12 , 13 , or 14 days ; or 15 , 16 , 17 , 18 , 19 , 20 , or 21 days ; or 25 9 , about 13 , or any 24 hour sustained plasma level factor in 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , or 31 days ; or 32 , 33 , 34 , a range bounded by, or between , any of these values, for the 35 , 36 , 37 , 38 , 39 , 40 , 41, 42 , 43 , 44 , or 45 ; or 46 , 47, 48 , particular species of mammal . 49 , 50 , 51, 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , or 60 days ; or 61 , An oral dosage form comprising zoledronic acid having a 62 , 63 , 64 , 65 , 66 , 67, 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , dose of zoledronic acid and a configuration suitable for a 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , or 90 days ; or 30 particular species ofmammal may be configured so that the 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , zoledronic acid has a 48 hour sustained plasma level factor 105 , 106 , 107 , 108, 109, 110 , 111 , 112 , 113 , 114 , 115 , 116 , of about 5 to about 20 , about 6 to about 15 , about 7 or 8 to 117 , 118 , 119 , or 120 days. about 12 or 13 , about 8 to about 10 , about 11 to about 13 , Oral administration of zoledronic acid , particularly oral about 8 , about 12 , or any 48 hour sustained plasma level administration of the disodium salt form of zoledronic acid ,, 35 factor in a range bounded by , or between , any of these can result in more sustained plasma levels of the drug as values , for the particular species of mammal. compared to parenteral modes of administration , such intra An oral dosage form comprising zoledronic acid having a venous or subcutaneous. For example , the amount of zole dose of zoledronic acid and a configuration suitable for a dronic acid in the plasma can be significantly higher for oral particular species ofmammal may be configured so that the administration of the disodium salt about 24 hours or 48+ 40 zoledronic acid has a 72 hour sustained plasma level factor hours , or longer, after administration . In some embodiments , of about 4 to about 20 , about 5 to about 10 , about 5 or 6 to oral zoledronic acid has a 24 hour sustained plasma level about 10 or 11 , about 5 to about 6 , about 9 to about 10 , about factor of about 1 or higher, such as about 1 to about 10 , about 6 , about 10 , or any 72 hour sustained plasma level factor in 1 to about 5 , about 3 to about 5 , or about 3 to about 4 . In a range bounded by , or between , any of these values, for the some embodiments , an orally administered dosage form of 45 particular species of mammal. zoledronic acid has a 24 hour sustained plasma level factor An oral dosage form comprising zoledronic acid having a or a 48 hour sustained plasma level factor that is higher, such dose of zoledronic acid and a configuration suitable for a as at least 1 . 2 times , at least about 2 times, at least about 5 particular species of mammal may be configured so that the times , about 1 . 2 times to about 20 times , about 2 times to particular species of mammal has a plasma concentration of about 15 times , about 5 times to about 10 times , or about o8 50 zoledronic acid at 12 hours that is about 0 .5 ng /mL to about to about 15 times that of intravenously administered zole 5 ng /mL , about 1 ng /mL to about 3 ng /mL , about 1 ng /mL dronic acid . A " sustained plasma level factor, ” Px is deter to about 2 ng /mL , about 2 ng /mL to about 3 ng/ mL , about mined by the equation : 3 ng /mL to about 4 ng /mL , about 1 . 2 ng /mL , about 2 .6 ng /mL , about 3 . 2 ng/ mL , or any plasma concentration in a p 1000 ( C / Cmax ) 55 range bounded by , or between , any of these values . wherein Cmor is the maximum plasma concentration of An oral dosage form comprising zoledronic acid having a zoledronic acid after it is administered and C , is the plasma dose of zoledronic acid and a configuration suitable for a concentration of zoledronic acid at the time of interest, such particular species of mammalmay be configured so that the as 24 hours . For parenteral administration , the Cmor can be particular species of mammal has a plasma concentration of about the Co, or the concentration right after injection of the 60 zoledronic acid at 24 hours that is about 0 . 2 ng /mL to about entire amount of the drug into the body . Sustained plasma 2 ng/ mL , about 0 . 5 ng /mL to about 1 . 5 ng/ mL , about 0 . 5 level factors can also be obtained for other times , such as 48 ng /mL to about 1 ng/ mL , about 1 ng /mL to about 1 . 5 ng /mL , hours , by using the plasma concentration of zoledronic acid about 0 . 5 ng /mL , about 1 .0 ng /mL , about 1. 4 ng/ mL , or any for C , in the equation above . For example , if the maximum plasma concentration in a range bounded by , or between , any plasma level of zoledronic acid after administration is 1000 65 of these values. ng /mL and the plasma level of zoledronic acid at 24 hours An oral dosage form comprising zoledronic acid having a is 1 ng/ mL , the 24 hour sustained plasma level factor is 1 . dose of zoledronic acid and a configuration suitable for a US 10 ,016 ,446 B2 29 30 particular species of mammal may be configured so that the tion , and loss . In some embodiments , zoledronic acid and particular species ofmammal has a plasma concentration of other bisphosphonates may be used to inhibit osteoclast zoledronic acid at 36 hours that is about 0 . 1 ng /mL to about activity and /or lower CTX serum levels , for example , by at 2 ng/ mL , about 0 . 2 ng/ mL to about 1 . 5 ng /mL , about 0 . 2 least about 5 % , at least about 10 % , at least about 15 % , at ng /mL to about 0 . 5 ng /mL , about 0 . 5 ng /mL to about 1 5 least about 20 % , at least about 25 % , at least about 30 % , at ng /mL , about 1 ng /mL to about 1 . 3 ng /mL , about 0 . 3 ng /mL , least about 35 % , at least about 40 % , at least about 45 % , at about 0 . 8 ng /mL , about 1 . 1 ng /mL , or any plasma concen - least about 50 % , at least about 55 % , at least about 60 % , at tration in a range bounded by, or between , any of these least about 70 % , at least about 75 % , at least about 80 % , at values . least about 85 % , at least about 90 % , at least about 95 % , at An oral dosage form comprising zoledronic acid having a 10 least about 99 % , at least about 100 % , about 60 % -70 % , about dose of zoledronic acid and a configuration suitable for a 70 % - 80 % , about 80 % - 90 % , about 85 - 95 % , about 80 % particular species of mammal may be configured so that the 85 % , about 85 % - 90 % , about 90 % - 95 % , or any other reduc particular species of mammal has a plasma concentration of tion in osteoclast activity or CTX serum levels in a range zoledronic acid at 48 hours that is about 0 . 1 ng /mL to about bounded by, or between , any of these values. 2 ng /mL , about 0 . 2 ng /mL to about 1 . 5 ng /mL , about 0 . 2 15 In some embodiments , zoledronic acid in a disodium salt ng/ mL to about 0 . 5 ng /mL , about 0 . 5 ng /mL to about 0 . 9 or an acid form and other bisphosphonates including salt or ng /mL , about 0 . 9 ng/ mL to about 1 . 3 ng/ mL , about 0 . 3 acid form may be used to treat Paget' s disease of Bone or ng /mL , about 0 . 7 ng /mL , about 1 . 1 ng /mL , or any plasma treat pain associated with Paget ' s disease of bone and /or concentration in a range bounded by, or between , any of lower serum alkaline phosphatase (ALP ) levels. For these values . 20 example , the reduction of ALP levels by at least about 20 % , An oral dosage form comprising zoledronic acid having a at least about 40 % , at least about 50 % , at least about 60 % , dose of zoledronic acid and a configuration suitable for a at least about 80 % , about 50 -60 % , about 60 - 80 % , about particular species of mammal may be configured so that the 80 - 90 % , about 90 - 95 % , or any other reduction in ALP levels particular species of mammal has a plasma concentration of in a range bounded by , or between , any of these values from zoledronic acid at 72 hours that is about 0 . 2 ng /mL to about 25 baseline , within 12 months , 18 months, or up to at least 5 1 ng/ mL , about 0 . 2 ng /mL to about 1 . 5 ng/ mL , about 0 . 1 years from the time of the last oral administration of ng /mL to about 0 . 3 ng /mL , about 0 . 3 ng /mL to about 0 . 6 zoledronic acid or other bisphosphonates. In some embodi ng /mL , about 0 .6 ng/ mL to about 1 ng /mL , about 0 . 2 ng /mL , ments , when zoledronic acid in a disodium salt or an acid about 0 . 5 ng /mL , about 0 . 9 ng /mL , or any plasma concen - form , or other bisphosphonate is administered to treat the tration in a range bounded by, or between , any of these 30 Paget' s disease of bone or pain associated with the Paget' s values . disease of bone , the Paget ' s disease or the pain associated An oral dosage form comprising zoledronic acid having a with the Paget ' s disease has recurrence rate of less than dose of zoledronic acid and a configuration suitable for a 20 % , less than 10 % , less than 5 % , less than 1 % , or does not particular species of mammal may be configured so that the return within 12 months, 18 months, or 5 years , or more , elimination half - life of zoledronic acid in the particular 35 from the time of the last oral administration of zoledronic species of mammal is about 30 hours to about 100 hours , acid , or other bisphosphonates . about 40 hours to about 60 hours , about 40 hours to about In some embodiments , a dosage form comprising a diso 50 hours, about 50 hours to about 60 hours, about 42 hours , dium salt of zoledronic acid is a solid . about 51 hours, about 59 hours, or any half- life in a range In some embodiments , a dosage form comprising a diso bounded by , or between , any of these values . 40 dium salt of zoledronic acid is used to treat an inflammatory As used herein , the " elimination half - life ” refers to the condition . apparent first- order terminal plasma elimination half - life, In some embodiments , a dosage form comprising a diso obtained by non - compartmental analysis using Win -Nonlin . dium salt of zoledronic acid is used to treat arthritis . A terminal plasma elimination half -life is the time required In some embodiments , a dosage form comprising a diso to reduce the plasma concentration to half after reaching 45 dium salt of zoledronic acid is used to treat complex regional pseudo - equilibrium , and not the time required to eliminate pain syndrome. half the administered dose. For orally administered drugs, In some embodiments , zoledronic acid is in a form that terminal plasma elimination half - life can be affected by has an aqueous solubility , meaning the solubility in water , absorption of the drug , as well as plasma clearance and greater than 1 % ( w / v ), about 5 % ( w / v ) to about 50 % ( w / v ) , extent of distribution . 50 about 5 % ( w / v ) to about 20 % ( w / v ) , about 10 % ( w / v ) to In some embodiments , the disodium salt form of zole about 15 % ( w / v ) , or about 12 % ( w / v ) to about 13 % ( w / v ) . dronic acid provides an enhancement to bioavailability , as The disodium salt form of zoledronic acid can be more compared to the diacid form of zoledronic acid , which adds compressible than the diacid form of zoledronic acid . This to any enhancement to bioavailability provided by any can make it easier for a dosage form to have a desired bioavailability - enhancing agents in the dosage form . In 55 hardness . It can also make it easier to increase the drug load , some embodiments , the disodium salt form of zoledronic so that a smaller tablet can be given for a given dosage acid provides an enhancement to bioavailability , as com - strength . In some embodiments, a solid dosage form of pared to the diacid form of zoledronic acid , which is greater zoledronic acid , such as the diacid form of zoledronic acid than any enhancement to bioavailability provided by any or the disodium salt form of zoledronic acid , can have a bioavailability - enhancing agents in the dosage form . In 60 hardness of about 5 kPa to about 20 kPa or about 5 kPa to some embodiments , the disodium salt form of zoledronic about 14 kPa . acid may be administered in a dosage form that is substan - Zoledronic acid or another bisphosphonate may be com tially free of bioavailability -enhancing agents . bined with a pharmaceutical carrier selected on the basis of The C - terminal telopeptide (CTX ) is one of the products the chosen route of administration and standard pharmaceu from type I collagen degradation by osteoclasts during bone 65 tical practice as described , for example , in Remington ' s resorption . Thus , CTX serum levels may be used as a Pharmaceutical Sciences , 2005 , the disclosure of which is biomarker to indicate and monitor bone breakdown, resorp - hereby incorporated herein by reference, in its entirety . The US 10 , 016 , 446 B2 31 32 relative proportions of active ingredient and carrier may be including transdermal, sublingual and buccal; topically ; determined , for example , by the solubility and chemical nasal inhalation via insufflation ; and rectal systemic . nature of the compounds, chosen route of administration and The effective amount of zoledronic acid or another bis standard pharmaceutical practice . phosphonate will vary depending on various factors known Zoledronic acid or another bisphosphonate may be admin - 5 to the treating physicians, such as the severity of the istered by any means that may result in the contact of the active agent( s ) with the desired site or site (s ) of action in the condition to be treated , route of administration , formulation body of a patient. The compounds may be administered by and dosage forms, physical characteristics of the bisphos any conventional means available for use in conjunction phonate compound used , and age , weight and response of with pharmaceuticals , either as individual therapeutic agents 10 the individual patients . or in a combination of therapeutic agents . For example , they In some embodiments , the daily oral dose of pamidronate may be administered as the sole active agents in a pharma is about 10 mg to about 1 , 000 mg, about 50 mg to about 500 ceutical composition , or they can be used in combination mg, about 100 mg to about 500 mg , or about 150 mg to about with other therapeutically active ingredients . 300 mg . In some embodiments , the parenteral dose of In some embodiments , an osteoclast inhibitor is co - 1515 pamidronatepamiaronate is about 5 mg to about 500 mg, about 5 mg to administered with a steroid . Suitable steroids include , for about 200 mg, or about 10 mg to about 150 mg. example , hydrocortisone , hydrocortisone acetate, cortisone In some embodiments , the daily oral dose of neridronate acetate , tixocortol pivalate , prednisolone , methylpredniso - is about 10 mg to about 1 , 000 mg, about 50 mg to about 500 lone , prednisone , triamcinolone acetonide , triamcinolone mg, about 100 mg to about 500 mg, or about 150 mg to about alcohol, mometasone , amcinonide, budesonide , desonide , 20 300 mg. In some embodiments , the parenteral dose of fluocinonide, fluocinolone acetonide , halcinonide , betame- neridronate is about 5 mg to about 500 mg, about 5 mg to thasone, betamethasone sodium phosphate , dexamethasone , about 200 mg, or about 10 mg to about 150 mg. dexamethasone sodium phosphate , fluocortolone , hydrocor In some embodiments , the daily oral dose of alendronate tisone - 17 -valerate , acleometasone dipropionate , betametha is about 0 .5 mg to about 200 mg, about 1 mg to about 100 sone valerate , betamethasone dippropionate , prednicarbate , 25 mg, about 5 mg to about 100 mg, or about 2 mg to about 50 clobetasone - 17 -butyrate , clobetasol- 17 - propionate , fluo - mg. In some embodiments , the parenteral dose of alendro cortilone caproate , fluocortolone pivalate , and fluprednidene acetate , hydrocortisone - 17 -butyrate , 17 -aceponate , 17 -bute nate is about 1 mg to about 100 mg, about 1 mg to about 40 prate , and prednicarbate . mg, or about 2 mg to about 30 mg. Any effective dose of steroid can be administered to a 30 is aIn some embodiments , the daily oral dose of olpadronate person . In some embodiment, the dose of a steroid may be is about 0 .5 mg to about 200 mg, about 1 mg to about 100 about 1 -500 mg, 5 - 25 mg, about 1 - 3 mg, about 2 - 4 mg, mg, about 5 mg to about 100 mg, or about 2 mg to about 50 about 3 - 5 mg, about 4 - 6 mg, about 5 - 7 mg, about 6 - 8 mg, mg. In some embodiments , the parenteral dose of olpadro about 7 - 9 mg, about 8 - 10 mg, about 10 - 15 mg, about 10 - 20 nate is about 1 mg to about 100 mg, about 1 mg to about 40 mg, about 20 - 50 mg, about 50 - 100 mg, about 100 - 200 mg. 35 mg, or about 2 mg to about 30 mg. about 200 - 300 mg about 300 - 400 mg 400 -500 mg 1 - 20 mg. In some embodiments , the daily oral dose of ibandronate about 10 - 30 mg, about 20 -40 mg, about 30 - 50 mg, about is about 0 . 25 mg to about 100 mg, about 0 . 5 mg to about 50 40 -60 mg, about 50 - 70 mg, about 60 - 80 mg, about 70 - 90 mg, about 2 . 5 mg to about 50 mg, or about 1 mg to about 25 mg, about 80 - 100 mg, about 90 - 110 mg , about 100 - 120 mg, mg. In some embodiments , the parenteral dose of ibandro about 110 - 130 mg, about 120 - 140 mg, about 130 - 150 mg, 40 nate is about 0 .5 mg to about 50 mg, about 0 .5 mg to about about 140 - 160 mg, about 150 - 170 mg, about 160 - 180 mg, 20 mg, or about 1 mg to about 15 mg . about 170 - 190 mg , about 180 - 200 mg, about 190 -210 mg, In some embodiments , the daily oral dose of risedronate about 200 -220 mg, about 210 -230 mg , about 220 - 240 mg, is about 0 . 25 mg to about 100 mg, about 0 . 5 mg to about 50 about 230 - 250 mg, about 240 - 260 mg, about 250 - 270 mg, mg, about 2 .5 mg to about 50 mg, or about 1 mg to about 25 about 260 - 280 mg , about 270 - 290 mg, about 280 - 300 mg, 45 mg. In some embodiments , the parenteral dose of risedro about 290 -310 mg, about 300 - 320 mg, about 310 - 330 mg, nate is about 0 .25 mg to about 25 mg , about 0 .25 mg to about about 320 - 340 mg, about 330 -350 mg, about 340 - 360 mg, 10 mg, or about 0 . 5 mg to about 7 . 5 mg. about 350 - 370 mg, about 360 -380 mg, about 370 - 390 mg , In some embodiments , the daily oral dose of zoledronate about 380 - 300 mg , about 390 -410 mg, about 400 - 420 mg, is about 0 .005 mg to about 20 mg, about 0 . 1 mg to about 10 about 410 - 430 mg , about 420 -440 mg, about 430 - 450 mg, 50 mg, about 0 .5 mg to about 10 mg, or about 0 . 2 mg to about about 440 - 460 mg, about 450 -470 mg, about 460 - 480 mg, 5 mg . In some embodiments , the parenteral dose of zole about 470 -490 mg, about 480 - 300 mg , about 490 -510 mg of dronate is about 0 .25 mg to about 25 mg, about 0 .25 mg to the steroid , or any amount in a range bounded by any of about 10 mg, or about 0 . 5 mg to about 7 .5 mg. these values. The dose of pamidronate , neridronate , olpadronate , alen The steroid can be given orally ( for example , 7 . 5 mg of 55 dronate , ibandronate , risedronate , zoledronate or another prednisone ) , by a separate infusion ( for example , 7 . 5 mg of bisphosphonate compound may be administered in a single methyl prednisolone ) , mixed in with zoledronic acid in the or divided dose . same infusion , or be administered intramuscularly , subcu - The amount of zoledronic acid or another bisphosphonate taneously , by rectal suppository, by inhalation , or injected in a therapeutic composition may vary. For example , some directly into a joint. 60 liquid compositions may comprise about 0 .0001 % ( w / v ) to Zoledronic acid or another bisphosphonate may be admin - about 50 % ( w / v ) , about 0 .01 % ( w / v ) to about 20 % ( w / v ) , istered to a human patient in a variety of forms adapted to about 0 . 01 % to about 10 % ( w / v ) , about 0 . 001 % ( w / v ) to the chosen route of administration , e . g ., orally , rectally , or about 1 % ( w / v ) , about 0 . 1 % ( w / v ) to about 0 . 5 % ( w / v ) , parenterally . Parenteral administration in this respect about 1 % ( w / v ) to about 3 % ( w / v ) , about 3 % ( w / v ) to about includes, but is not limited to , administration by the follow - 65 5 % ( w / v ) , about 5 % ( w / v ) to about 7 % ( w / v ) , about 7 % ing routes : pulmonary , intrathecal, intravenous , intramuscu - ( w / v ) to about 10 % ( w / v ) , about 10 % ( w / v ) to about 15 % lar , subcutaneous, intraocular, intrasynovial , transepithelial (w /v ), about 15 % ( w / v ) to about 20 % ( w / v ), about 20 % US 10 , 016 , 446 B2 33 34 ( w / v ) to about 30 % ( w / v ) , about 30 % ( w / v ) to about 40 % osteoclast inhibitor is administered daily , weekly , biweekly , ( w / v ), or about 40 % ( w /v ) to about 50 % ( w / v ) of zoledronic monthly , every two or three months , once a year , or twice a acid . yayear . Some solid compositionsmay comprise at least about 5 % Any suitable amount of an osteoclast inhibitor, including ( w / w ) , at least about 10 % ( w / w ) , at least about 20 % ( w / w ) , 5 a bisphosphonate , such as a nitrogen -containing bisphos at least about 50 % ( w / w ), at least about 70 % ( w / w ) , at least phonate , e . g . zoledronic acid , neridronate ( neridronic acid ) , about 80 % , about 10 % ( w / w ) to about 30 % ( w / w ) , about pamidronate , olpadronate , alendronate , risedronate , mino 10 % ( w / w ) to about 20 % (w /w ), about 20 % ( w /w ) to about dronic acid , or ibandronic acid , may be used . Some solid or 30 % ( w / w ) , about 30 % ( w / w ) to about 50 % ( w / w ) , about liquid dosage forms, or units of dosage forms may contain 30 % ( w / w ) to about 40 % ( w / w ) , about 40 % ( w / w ) to about 10 about 0 . 005 mg to about 20 mg, about 0 . 1 mg to about 10 50 % ( w / w ) , about 50 % ( w / w ) to about 80 % ( w / w ) , about mg, about 0 . 5 mg to about 10 mg, about 0 . 2 mg to about 5 50 % ( w /w ) to about 60 % (w /w ), about 70 % ( w / w ) to about mg, about 1 mg to about 500 mg, about 1 mg to about 50 mg, 75 % ( w / w ), about 70 % (w /w ) to about 80 % ( w /w ) , or about about 10 mg to about 250 mg, about 100 mg to about 300 80 % ( w / w ) to about 90 % ( w / w ) of zoledronic acid . mg, about 20 mg to about 200 mg, about 20 mg to about 150 Any suitable amount of an osteoclast inhibitor, including 15 mg, about 30 mg to about 100 mg, about 50 mg to about 200 a bisphosphonate , such as a nitrogen - containing bisphos - mg, about 1 mg to about 1 ,000 mg, about 10 mg to about 50 phonate, e . g . zoledronic acid , minodronic acid , or iban - mg, about 40 mg to about 60 mg, about 50 mg to about 60 dronic acid , may be used . Some solid or liquid oral dosage mg, about 55 mg, about 10 mg to about 300 mg, about 10 forms, or units of oral dosage forms ( referred to collectively mg to about 150 mg, about 10 mg to about 100 mg, about herein as “ oral dosage form ( s ) ” ) may contain about 0 . 005 20 40 mg to about 150 mg, about 10 mg to about 600 mg, about mg to about 20 mg , about 0 . 1 mg to about 10 mg, about 0 . 5 40 mg to about 600 mg, about 40 mg to about 2000 mg, mg to about 10 mg, about 0 .2 mg to about 5 mg, about 1 mg about 40 mg to about 800 mg, about 25 mg to about 800 mg, to about 500 mg, about 1 mg to about 50 mg, about 10 mg about 30 mg to about 800 mg, about 10 mg to about 500 mg, to about 250 mg, about 100 mg to about 300 mg, about 20 about 50 mg to about 150 mg, about 50 mg, about 100 mg, mg to about 200 mg, about 20 mg to about 150 mg, about 25 about 50 mg to about 500 mg, about 150 mg to about 200 30 mg to about 100 mg, about 50 mg to about 200 mg, about mg, about 100 mg to about 2000 mg, about 300 mg to about 1 mg to about 1 , 000 mg, about 10 mg to about 50 mg, about 1500 mg, about 200 mg to about 1000 mg, about 100 mg to 40 mg to about 60 mg , about 50 mg to about 60 mg, about about 500 mg, about 160 mg, or about 150 mg of zoledronic 55 mg, about 10 mg to about 300 mg, about 10 mg to about acid in an acid form or in a salt form such as disodium salt 150 mg, about 10 mg to about 100 mg, about 40 mg to about 30 form , or any amount of osteoclast inhibitor in a range 150 mg , about 10 mg to about 600 mg, about 40 mg to about bounded by , or between , any of these values . In some 600 mg, about 40 mg to about 2000 mg, about 40 mg to embodiments , the oral or IV osteoclast inhibitor is admin about 800 mg, about 25 mg to about 800 mg, about 30 mg istered daily, every other day , every third day , weekly , to about 800 mg, about 10 mg to about 500 mg, about 50 mg biweekly, monthly , every two or three months, every six to about 150 mg , about 50 mg, about 100 mg , about 50 mg 35 months , once a year , or twice a year from day 1 . to about 500 mg, about 150 mg to about 200 mg, about 100 Some dosage formsmay contain about 0 .005 mg to about mg to about 2000 mg, about 300 mg to about 1500 mg , about 20 mg, about 0 . 1 mg to about 10 mg , about 0 . 5 mg to about 200 mg to about 1000 mg, about 100 mg to about 500 mg, 10 mg, about 0 . 2 mg to about 5 mg, about 1 mg to about 500 about 160 mg, or about 150 mg of zoledronic acid in an acid mg , about 1 mg to about 50 mg, about 10 mg to about 250 form or in a salt form such as disodium salt form , or any 40 mg, about 100 mg to about 300 mg, about 20 mg to about amount of osteoclast inhibitor in a range bounded by , or 200 mg, about 20 mg to about 150 mg, about 30 mg to about between , any of these values . In some embodiments , the oral 100 mg, about 1 mg to about 1 , 000 mg, about 10 mg to about osteoclast inhibitor is administered daily , weekly , biweekly , 50 mg, about 40 mg to about 60 mg, about 50 mg to about monthly, every two or three months, once a year , or twice a 65 mg, about 65 mg to about 70 mg, about 50 mg to about year. 45 60 mg, about 55 mg, about 10 mg to about 300 mg, about Some oral dosage forms may contain about 0 . 005 mg to 10 mg to about 150 mg, about 10 mg to about 100 mg, about about 20 mg, about 0 . 1 mg to about 10 mg, about 0 . 5 mg to 40 mg to about 150 mg, about 10 mg to about 600 mg, about about 10 mg , about 0 . 2 mg to about 5 mg, about 1 mg to 40 mg to about 600 mg , about 100 mg to about 600 mg, about 500 mg , about 1 mg to about 50 mg, about 10 mg to about 40 mg to about 2000 mg , about 40 mg to about 800 about 250 mg, about 100 mg to about 300 mg, about 20 mg 50 mg, about 25 mg to about 800 mg, about 30 mg to about 800 to about 200 mg , about 20 mg to about 150 mg, about 30 mg mg, about 10 mg to about 500 mg, about 50 mg to about 150 to about 100 mg, about 1 mg to about 1 ,000 mg, about 10 mg, about 50 mg, about 100 mg, about 50 mg to about 200 mg to about 50 mg, about 40 mg to about 60 mg, about 50 mg, about 50 mg to about 500 mg, about 150 mg to about mg to about 60 mg , about 55 mg, about 10 mg to about 300 200 mg, about 100 mg to about 2000 mg, about 300 mg to mg , about 10 mg to about 150 mg, about 10 mg to about 100 55 about 1500 mg , about 200 mg to about 1000 mg, about 100 mg, about 40 mg to about 150 mg, about 10 mg to about 600 mg to about 500 mg, about 160 mg, or about 150 mg of mg, about 40 mg to about 600 mg, about 40 mg to about osteoclast inhibitor, or any amount of osteoclast inhibitor in 2000 mg, about 40 mg to about 800 mg, about 25 mg to a range bounded by, or between , any of these values . In some about 800 mg, about 30 mg to about 800 mg, about 10 mg embodiments , the oral or IV osteoclast inhibitor is admin to about 500 mg, about 50 mg to about 150 mg , about 50 mg, 60 istered daily , every other day, every third day, weekly , about 100 mg, about 50 mg to about 200 mg, about 50 mg biweekly , monthly , every two or three months , every 6 to about 500 mg, about 150 mg to about 200 mg, about 100 months, once a year , or twice a year from day 1 . mg to about 2000 mg, about 300 mg to about 1500 mg, about In some embodiments , an oral dosage form may contain 200 mg to about 1000 mg, about 100 mg to about 500 mg, about 10 mg/m² to about 20 mg/m² , about 15 mg/m² to about about 160 mg, or about 150 mg ofosteoclast inhibitor , or any 65 20 mg/ m² , about 18 mg/m² , about 80 mg/ m² to about 150 amount of osteoclast inhibitor in a range bounded by , or mg/ m² , about 90 mg/m2 to about 150 mg/m² , about 100 between , any of these values . In some embodiments , the oral mg/m² to about 150 mg/ m² of zoledronic acid , or any US 10 , 016 , 446 B2 35 36 amount of zoledronic in a range bounded by, or between , any amount in a range bounded by, or between , any of these of these values . All dosage ranges or amounts expressed in values . The weekly oral dose may be given as a single dose , mg/ m are based upon the body surface area of the mammal. given once during the week , or may be given in 2 , 3 , 4 , 5 , In some embodiments , the daily oral dose of an osteoclast 6 , or 7 individual doses during the week . inhibitor , including a bisphosphonate , such as a nitrogen - 5 In some embodiments the weekly oral dose of zoledronic containing bisphosphonate , e . g . zoledronic acid , minodronic acid is about 1 mg to about 1000 mg, about 1 mg to about acid , or ibandronic acid , is about 0 . 005 mg to about 20 mg, 500 mg, about 10 mg to about 250 mg, about 100 mg to about 0 . 1 mg to about 10 mg, about 0 . 5 mg to about 10 mg, about 300 mg, about 10 mg to about 100 mg, about 10 mg about 0 . 2 mg to about 5 mg, or any amount in a range to about 150 mg, about 10 mg to about 100 mg, about 10 mg bounded by, or between , any of these values. In some 10 to about 300 mg, about 20 mg to about 150 mg, about 20 mg embodiments , the daily oral dose of osteoclast inhibitor is to about 60 mg, about 30 mg to about 70 mg, about 40 mg less than about 35 mg/m² , less than about 30 mg/ m², less to about 60 mg, about 50 mg to about 70 mg , about 50 mg, than about 25 mg/ m² , about 1 mg/ m² to about 35 mg/m² , about 55 mg, about 100 mg to about 150 mg, or about 30 mg 25about mg 1/ m2 mg / m²about to about1. 8 mg 30/ m2 mg / tom² about, about 20 1 .mg 5 mg /m2 / m² about to about 10 15 to about 100 mg . In some embodiments , the weekly oral mg/ m² to about 20 mg/ m² , about 10 mg/ m2 to about 30 dose of zoledronic acid is less than about 250 mg/ m² , less mg/m² , about 15 mg/ m² to about 20 mg/m² , about 18 than about 200 mg/ m “ , less than about 175 mg/ m “ , about 6 mg/m² , or any amount of zoledronic acid in a range bounded mg/m² to about 250 mg/m² , about 10 mg/ m² to about 210 by, or between , any of these values . mg/ m² , about 10 mg/m² to about 170 mg/ m² , about 4 mg/ m² In some embodiments , the daily oral dose of an osteoclast 20 to about 140 mg/m² , about 100 mg/ m2 to about 140 mg/ m² , inhibitor, including a bisphosphonate , such as a nitrogen - about 126 mg/ m² , or any amount of zoledronic acid in a containing bisphosphonate , e .g . zoledronic acid , minodronic range bounded by, or between , any of these values . The acid , or ibandronic acid , is about 0 .005 mg to about 20 mg, weekly oral dose may be given as a single dose , given once about 0 . 1 mg to about 10 mg, about 0 . 5 mg to about 10 mg, during the week , or may be given in 2 , 3 , 4 , 5 , 6 , or 7 about 0 . 2 mg to about 5 mg, or any amount of osteoclast 25 individual doses during the week . inhibitor in a range bounded by , or between , any of these In some embodiments, the monthly dose of the osteoclast values . In some embodiments , the daily oral dose of osteo - inhibitor, including a bisphosphonate , such as a nitrogen clast inhibitor is less than about 35 mg/m² , less than about containing bisphosphonate , e . g . zoledronic acid ,minodronic 30 mg/m² , less than about 25 mg/m² , about 1 mg/ m² to about acid , or ibandronic acid , or the amount of the osteoclast 35 mg/ m² , about 1 mg/ m² to about 30 mg/ m² , about 1 .5 30 inhibitor that is administered over a period of a month , is mg/m² to about 25 mg/ m² , about 1. 8 mg/ m² to about 20 about 5000 mg or less , about 4000 mg or less , about 3000 mg/m² , about 10 mg/ m² to about 20 mg/ m² , about 10 mg/ m² mg or less, about 2000 mg or less , about 1000 mg or less , to about 30 mg/ m² , about 15 mg/ m2 to about 20 mg/ m² , about 700 mg or less, about 600 mg or less, about 1 mg to about 18 mg/ m ” , or any amount of osteoclast inhibitor in a about 4 ,000 mg, about 1 mg to about 1 ,000 mg, about 10 mg range bounded by , or between , any of these values . 35 to about 1000 mg, about 50 mg to about 1000 mg, about 10 In some embodiments the daily oral dose of zoledronic mg to about 600 mg, about 40 mg to about 600 mg, about acid is about 0 . 005 mg to about 20 mg, about 0 . 1 mg to about 50 mg to about 600 mg, about 40 mg to about 400 mg, about 10 mg, about 0 . 5 mg to about 10 mg, about 0 . 2 mg to about 50 mg to about 200 mg , about 200 mg to about 300 mg, 5 mg, or any amount of zoledronic acid in a range bounded about 250 mg to about 350 mg, or about 100 mg to about 600 by , or between , any of these values. In some embodiments , 40 mg , about 40 mg to about 2000 mg, about 40 mg to about the daily oral dose of zoledronic acid is less than about 35 800 mg, about 50 mg to about 800 mg, or about 100 mg to mg/m² , less than about 30 mg/m² , less than about 25 mg/ m² , about 800 mg, about 40 mg to about 1000 mg, about 50 mg about 1 mg/m² to about 35 mg/ m², about 1 mg/ m² to about to about 1000 mg, or about 100 mg to about 1000 mg, or any 30 mg/ m² , about 1. 5 mg/ m² to about 25 mg/m² , about 1 .8 monthly dose in a range bounded by, or between , any of mg/ m? to about 20 mg/ m ” , about 10 mg/ m ^ to about 20 45 these values . In some embodiments , the monthly oral dose mg/m² , about 10 mg /m² to about 30 mg /m² , about 15 mg/ m² of the osteoclast inhibitor is less than about 1000 mg/ m² , to about 20 mg/m² , about 18 mg/ m² , or any amount of less than about 800 mg/m² , less than about 600 mg/ m² , zoledronic acid in a range bounded by, or between , any of about 10 mg/ m² to about 1000 mg/ m² , about 50 mg/ m² to these values . about 800 mg/ m² , about 70 mg/m2 to about 700 mg/m² , In some embodiments , the weekly oral dose of the osteo - 50 about 100 mg/m² to about 700 mg/ m² , about 100 mg/ m² to clast inhibitor, including a bisphosphonate , such as a nitro - about 600 mg/ m ” , about 50 mg/ m ? to about 200 mg/ m ” , gen - containing bisphosphonate , e . g . zoledronic acid , mino - about 300 mg/ m² to about 600 mg/m² , about 450 mg/m² to dronic acid , ibandronic acid , is about 1 mg to about 1000 about 600 mg/ m² , about 300 mg/ m² to about 1000 mg/ m² , mg , about 1 mg to about 500 mg, about 10 mg to about 250 about 400 mg/ m² to about 1000 mg/m² , about 500 mg/m² to mg , about 100 mg to about 300 mg, about 10 mg to about 55 about 1000 mg/m² , about 400 mg/ m² to about 700 mg/ m² , 100 mg, about 10 mg to about 150 mg, about 10 mg to about about 500 mg/ m² to about 600 mg/m² , about 540 mg/m² , or 100 mg, about 10 mg to about 300 mg, about 20 mg to about any amount in a range bounded by, or between , any of these 150 mg, about 20 mg to about 60 mg, about 30 mg to about values. A monthly dose may be given as a single dose , or as 70 mg, about 40 mg to about 60 mg, about 50 mg to about two or more individual doses administered during the 70 mg , about 50 mg, about 55 mg, about 100 mg to about 60 month . In some embodiments , the monthly dose is admin 150 mg, or about 30 mg to about 100 mg. In some embodi- istered in 2 or 3 weekly doses. In some embodiments , the ments , the weekly oral dose of the osteoclast inhibitor is less monthly dose is administered in 4 or 5 weekly doses . In than about 250 mg/ m² , less than about 200 mg/ m² , less than some embodiments , the monthly dose is administered in 28 about 175 mg/m² , about 6 mg/ m² to about 250 mg/ m² , about to 31 daily doses. In some embodiments , the monthly dose 10 mg/m² to about 210 mg/ m² , about 10 mg/ m² to about 170 65 is administered in 5 to 10 individual doses during the month . mg/ m ” , about 4 mg / m to about 140 mg/ m ” , about 100 The monthly dose may be administered for only 1 month , or mg/ m² to about 140 mg/m² , about 126 mg/ m² , or any may be repeatedly administered for 2 or more months. US 10 ,016 ,446 B2 37 38 In some embodiments , the monthly dose of zoledronic 3 . 9 mg/ kg to about 4 mg/ kg , about 0 . 4 mg/ kg to about 0 .6 acid , or the amount of zoledronic acid that is administered mg/ kg , about 0 .6 mg/ kg to about 0 . 8 mg/ kg , about 0 . 8 mg/ kg over a period of a month , is about 5000 mg or less , about to about 1 mg/ kg , about 1 mg /kg to about 1 . 2 mg/ kg , about 4000 mg or less , about 3000 mg or less, about 2000 mg or 1 . 2 mg/kg to about 1 . 4 mg/kg , about 1 . 4 mg/ kg to about 1 . 6 less , about 1000 mg or less , about 700 mg or less , about 600 5 mg/kg , about 1 . 6 mg/ kg to about 1 . 8 mg/kg , about 1 . 8 mg/ kg mg or less , about 1 mg to about 4 ,000 mg, about 1 mg to to about 2 mg/ kg , about 2 mg/ kg to about 2 . 2 mg/ kg , about about 1 , 000 mg, about 10 mg to about 1000 mg, about 50 mg 2 . 2 mg/ kg to about 2 . 4 mg/ kg , about 2 . 4 mg /kg to about 2 . 6 to about 1000 mg, about 10 mg to about 600 mg, about 40 mg/kg , about 2 .6 mg/kg to about 2 . 8 mg/ kg , about 2 . 8 mg/ kg mg to about 600 mg, about 50 mg to about 600 mg, about to about 3 mg/ kg , about 3 mg/ kg to about 3 . 2 mg/ kg , about 40 mg to about 400 mg , about 50 mg to about 200 mg, about 10 3 . 2 mg/ kg to about 3 . 4 mg/kg , about 3 . 4 mg/ kg to about 3 . 6 200 mg to about 300 mg, about 250 mg to about 350 mg, or mg/ kg , about 3 .6 mg/ kg to about 3 . 8 mg/ kg , about 3 . 8 mg/ kg about 100 mg to about 600 mg, about 40 mg to about 2000 to about 4 mg/kg , about 0 . 4 mg/ kg to about 0 . 7 mg/ kg , about mg, about 40 mg to about 800 mg , about 50 mg to about 800 0 .7 mg/ kg to about 1 mg/ kg , about 1 mg/ kg to about 1 . 3 mg, or about 100 mg to about 800 mg, about 40 mg to about mg/ kg , about 1 . 3 mg/ kg to about 1 . 6 mg/ kg , about 1 . 6 mg/ kg 1000 mg, about 50 mg to about 1000 mg, or about 100 mg 15 to about 1 . 9 mg/kg , about 1 . 9 mg/ kg to about 2 . 2 mg/ kg , to about 1000 mg, or any monthly dose in a range bounded about 2 . 2 mg/ kg to about 2 . 5 mg/ kg , about 2 . 5 mg /kg to by, or between , any of these values. In some embodiments , about 2 . 8 mg/ kg , about 2 . 8 mg/ kg to about 3 mg/ kg , about the monthly oral dose of zoledronic acid is less than about 3 .3 mg/ kg to about 3 .6 mg/ kg , about 3 .6 mg /kg to about 4 1000 mg/m2 , less than about 800 mg/m2 , less than about 600 mg/ kg , about 0 . 4 mg/ kg to about 1 mg /kg , or about 0 . 5 mg/ m² , about 10 mg/m² to about 1000 mg/m² , about 50 20 mg/kg to about 1 mg/ kg ,may be a safe dose for repeated oral mg/m² to about 800 mg/ m ” , about 70 mg/m² to about 700 administration , such as once daily dosing to once yearly mg/ m² , about 100 mg /m² to about 700 mg/ m² , about 100 dosing , once daily dosing to twice yearly dosing , once daily mg /m² to about 600 mg/ m² , about 50 mg/ m² to about 200 dosing to thrice yearly dosing , once daily dosing to dosing mg/m² , about 300 mg/m² to about 600 mg/m² , about 450 every three months , once daily dosing to dosing every two mg/ m? to about 600 mg/ m ” , about 300 mg/ m ' to about 1000 25 months , once daily dosing to dosing every two months , once mg/ m² , about 400 mg/ m² to about 1000 mg/ m² , about 500 daily dosing to dosing every month , once daily dosing to mg/ m² to about 1000 mg/ m ” , about 400 mg/m² to about 700 dosing every 2 - 4 weeks, once daily dosing to once weekly mg/m² , about 500 mg/ m² to about 600 mg/m² , about 540 dosing , etc . mg/ m² , or any amount of zoledronic acid in a range bounded The doses referred to in the paragraph above for admin by, or between, any of these values . A monthly dose may be 30 istration of zoledronic acid to a mammal may be safely given as a single dose , or as two or more individual doses administered 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , or 15 administered during the month . In some embodiments , the times , or about 3 to about 10 times , once a day , or less monthly dose is administered in 2 or 3 weekly doses. In frequently , such as once week , once every two weeks, once some embodiments , the monthly dose is administered in 4 or a month , etc . 5 weekly doses . In some embodiments, the monthly dose is 35 For once daily to once weekly oral administration of administered in 28 to 31 daily doses. In some embodiments, zoledronic acid to a mammal such as a mouse , rat, dog , the monthly dose is administered in 5 to 10 individual doses primate , or a human being , in some embodiments , a safely during the month . The monthly dose may be administered repeated dose may be about 0 . 03 mg/ kg to about 4 mg/ kg , for only 1 month , or may be repeatedly administered for 2 or any smaller range within this range, such as about 0 . 01 or more months . 40 mg/kg to about 0 . 02 mg/ kg , about 0 .02 mg/ kg to about 0 . 03 With respect to orally administering zoledronic acid to a mg/ kg , about 0 .03 mg/ kg to about 0 .04 mg/ kg , about 0 . 04 mammal, such as a dog , a rat, a rabbit , a monkey , an ape , or mg/ kg to about 0 .05 mg/ kg , about 0 .05 mg /kg to about 0 . 06 a human being , doses of about 0 .03 mg/ kg to about 10 mg/ kg , about 0 .06 mg /kg to about 0 .07 mg/ kg , about 0 . 07 mg/ kg , or any smaller range within this range , such as about mg/ kg to about 0 .08 mg/ kg , about 0 .08 mg/ kg to about 0 .09 0 .4 mg/ kg to about 3 mg/ kg , about 0 . 4 mg/ kg to about 1 . 5 45 mg/ kg , about 0 .09 mg/ kg to about 0 . 1 mg/ kg , about 0 . 1 mg /kg , mg/ kg , about 0 . 4 mg/ kg to about 0 . 5 mg/ kg , about mg/ kg to about 0 . 11 mg/ kg , about 0 . 11 mg/ kg to about 0 . 12 0 .5 mg/ kg to about 0 . 6 mg/ kg , about 0 . 6 mg/ kg to about 0 . 7 mg/ kg , about 0 . 12 mg/ kg to about 0 . 13 mg/ kg , about 0 . 13 mg /kg , about 0 . 7 mg/ kg to about 0 . 8 mg /kg , about 0 . 8 mg/ kg mg/ kg to about 0 . 14 mg/ kg , about 0 . 14 mg/kg to about 0 . 15 to about 0 . 9 mg/ kg , about 0 .9 mg/ kg to about 1 mg/ kg , about mg/ kg , about 0 . 15 mg/ kg to about 0 . 16 mg/ kg , about 0 . 16 1 mg/ kg to about 1 . 1 mg/ kg , about 1 . 1 mg/ kg to about 1 . 2 50 mg/ kg to about 0 . 17 mg/ kg , about 0 . 17 mg /kg to about 0 . 18 mg/ kg , about 1 . 2 mg/ kg to about 1 . 3 mg/ kg , about 1 . 3 mg/ kg mg/ kg , about 0 . 18 mg/ kg to about 0 . 19 mg/ kg , about 0 . 19 to about 1 . 4 mg/ kg , about 1 . 4 mg/ kg to about 1 . 5 mg/ kg , mg/kg to about 0 . 2 mg/kg , about 0 . 2 mg/ kg to about 0 .21 about 1 . 5 mg/ kg to about 1 . 6 mg/ kg , about 1 . 6 mg/ kg to mg/ kg , about 0 .21 mg/ kg to about 0 .22 mg/ kg , about 0 . 22 about 1. 7 mg/ kg , about 1. 7 mg/ kg to about 1. 8 mg/ kg , about mg/ kg to about 0 .23 mg/ kg , about 0 .23 mg/ kg to about 0 . 24 1 . 8 mg/ kg to about 1 . 9 mg /kg , about 1 . 9 mg/ kg to about 2 55 mg/ kg , about 0 .24 mg/ kg to about 0 . 25 mg/ kg , about 0 .25 mg/ kg , about 2 mg/ kg to about 2 . 1 mg /kg , about 2 . 1 mg/kg mg/ kg to about 0 . 26 mg/ kg , about 0 .26 mg /kg to about 0 .27 to about 2 . 2 mg/ kg , about 2 . 2 mg/ kg to about 2 . 3 mg/ kg , mg/ kg , about 0 .27 mg/ kg to about 0 . 28 mg/ kg , about 0 . 28 about 2 . 3 mg/ kg to about 2 . 4 mg/ kg , about 2 .4 mg/ kg to mg/kg to about 0 . 29 mg/ kg , about 0 . 29 mg/ kg to about 0 . 3 about 2 .5 mg/ kg , about 2 . 5 mg/ kg to about 2 .6 mg/ kg , about mg/ kg , about 0 .3 mg/ kg to about 0 .31 mg/ kg , about 0 .31 2 . 6 mg/kg to about 2 . 7 mg/kg , about 2 . 7 mg/ kg to about 2 . 8 60 mg/kg to about 0 . 32 mg/ kg , about 0 .32 mg/ kg to about 0 . 33 mg/ kg , about 2 . 8 mg/ kg to about 2 . 9 mg/ kg , about 2 . 9 mg/ kg mg/ kg , about 0 .33 mg /kg to about 0 . 34 mg/ kg , about 0 . 34 to about 3 mg/ kg , about 3 mg/ kg to about 3 . 1 mg/ kg , about mg/ kg to about 0 . 35 mg/ kg , about 0 .35 mg/ kg to about 0 . 36 3 . 1 mg/ kg to about 3 . 2 mg/kg , about 3 . 2 mg/ kg to about 3 . 3 mg/ kg , about 0 . 36 mg/ kg to about 0 .37 mg/ kg , about 0 . 37 mg/ kg , about 3 . 3 mg/ kg to about 3 . 4 mg/ kg , about 3 . 4 mg/ kg mg/ kg to about 0 . 38 mg/ kg , about 0 . 38 mg/ kg to about 0 . 39 to about 3 .5 mg/ kg , about 3 . 5 mg/ kg to about 3 . 6 mg/ kg , 65 mg/ kg , about 0 .39 mg/ kg to about 0 .4 mg/ kg , about 0 . 05 about 3 . 6 mg/ kg to about 3 . 7 mg/ kg , about 3 . 7 mg/ kg to m g /kg to about 0 . 2 mg/ kg , about 0 . 05 mg/kg to about 0 . 15 about 3 . 8 mg/ kg , about 3 . 8 mg/ kg to about 3 . 9 mg/kg , about mg/ kg , about 0 .06 mg/ kg to about 0 . 15 mg/ kg , about 0 .07 US 10 ,016 , 446 B2 39 40 mg/kg to about 0 .15 mg/ kg , about 0 .08 mg/ kg to about 0 . 15 about 1 mg/kg , about 0 .6 mg/ kg to about 1 mg/ kg , about 0 . 7 mg/ kg , about 0 . 09 mg/kg to about 0 . 15 mg/ kg , about 0 . 1 mg/kg to about 1 mg/ kg , about 0 . 8 mg/ kg to about 1 mg/ kg , mg/ kg to about 0 . 15 mg/ kg , about 0 . 03 mg/ kg to about 0 . 5 or about 0 . 8 mg / kg to about 0 . 9 mg/kg . mg/ kg , about 0 . 06 mg/ kg to about 0 . 2 mg/ kg , about 0 .07 In some embodiments , the osteoclast inhibitor comprises mg/ kg to about 0 . 2 mg /kg , about 0 .08 mg/ kg to about 0 . 2 5 zoledronic acid , and the oral zoledronic acid , or disodium mg /kg , about 0 . 09 mg/ kg to about 0 . 2 mg/ kg , about 0 . 1 salt thereof , may be administered in combination with about mg/ kg to about 0 .2 mg/ kg , about 0 .4 mg to about 4 mg, 0 . 1 mg to about 10 mg of zoledronic acid , or a salt thereof, about 0 . 4 mg/ kg to about 0 .6 mg/ kg , about 0 . 6 mg/ kg to administered parenterally , such as intravenously . In some about 0 . 8 mg/ kg , about 0 . 8 mg/ kg to about 1 mg/ kg , about embodiments , about 50 mg, about 100 mg , or about 150 mg 1 mg/ kg to about 1 . 2 mg/ kg , about 1 . 2 mg/ kg to about 1 . 4 10 of the disodium salt of zoledronic acid is administered orally mg/ kg , about 1 . 4 mg/ kg to about 1 . 6 mg/ kg , about 1 .6 mg/ kg in combination with 1 mg parenteral, such as intravenous , to about 1 . 8 mg/ kg , about 1. 8 mg/kg to about 2 mg/ kg , about zoledronic acid . In some embodiments the parenteral dose of 2 mg/kg to about 2 . 2 mg/kg , about 2 . 2 mg/ kg to about 2 . 4 zoledronic acid is about 0 .25 mg to about 25 mg, about 0 . 25 mg/ kg , about 2 . 4 mg/ kg to about 2 . 6 mg/ kg , about 2 .6 mg/ kg mg to about 10 mg, or about 0 . 5 mg to about 7 . 5 mg. to about 2 . 8 mg/ kg , about 2 . 8 mg/ kg to about 3 mg/ kg , about 15 With respect to oral administration of an osteoclast inhibi 3 mg/ kg to about 3 . 2 mg/ kg , about 3 . 2 mg/ kg to about 3 . 4 tor , such as zoledronic acid , minodronic acid , ibandronic mg/ kg , about 3 . 4 mg/kg to about 3 . 6 mg/ kg , about 3 . 6 mg/ kg acid , or another bisphosphonate , for the treatment of pain to about 3 . 8 mg/ kg , about 3 . 8 mg/ kg to about 4 mg/ kg , about associated with inflammation , arthritis , CRPS , or any other 0 . 5 mg/ kg to about 2 mg/ kg , about 0 . 6 mg/ kg to about 2 condition recited herein , it may helpful if the mammal or mg/ kg , about 0 . 7 mg/ kg to about 2 mg /kg , about 0 . 8 mg/kg 20 human being to which the osteoclast inhibitor is adminis to about 2 mg/ kg , about 0 . 5 mg/ kg to about 1 . 5 mg/ kg , about tered does not eat food or drink beverage , (other than any 0 .6 mg/ kg to about 1 . 5 mg/ kg , about 0 . 7 mg/ kg to about 1 . 5 water required to swallow the oral dosage form ) for at least mg/ kg , about 0 . 8 mg/ kg to about 1 . 5 mg/ kg , about 0 . 5 mg/kg about 1 hour, at least about 2 hours, at least about 4 hours , to about 0 . 9 mg/ kg , about 0 . 6 mg /kg to about 0 . 9 mg/ kg , at least about 6 hours, at least about 8 hours , at least about about 0 . 7 mg/kg to about 0 . 9 mg/ kg , about 0 . 5 mg/ kg to 25 10 hours , or at least about 12 hours before the osteoclast about 1 mg/kg , about 0 .6 mg/ kg to about 1 mg/ kg , about 0 . 7 inhibitor is administered . It may also be helpful if the mg/ kg to about 1 mg/ kg , about 0 . 8 mg/ kg to about 1 mg/ kg , mammal or human being to which the osteoclast inhibitor is or about 0 . 8 mg/ kg to about 0 . 9 mg/ kg . administered does not eat food or drink beverage for at least For once weekly or less frequent oral administration of about 30 minutes, at least about 1 hour, at least about 2 zoledronic acid to a mammal such as a mouse , rat, dog, 30 hours , at least about 3 hours , or at least about 4 hours after primate , or a human being , in some embodiments, a safely the osteoclast inhibitor is administered . In some embodi repeated dose may be about 0 . 4 mg to about 10 mg, or any ments , a human being to which the zoledronic acid is smaller range within this range , such as about 0 . 4 mg/ kg to administered avoids lying down , or remains upright or sits about 0 . 6 mg/ kg , about 0 .6 mg/ kg to about 0 . 8 mg/ kg , about upright, for at least about 30 minutes or about 1 hour after 0 . 8 mg/ kg to about 1 mg/ kg , about 1 mg/kg to about 1 . 2 35 receiving a dosage form containing the osteoclast inhibitor . mg/ kg , about 1 . 2 mg/ kg to about 1 . 4 mg/ kg , about 1 . 4 mg/ kg Avoiding food or beverage before or after oral administra to about 1 . 6 mg/ kg , about 1 . 6 mg/ kg to about 1 . 8 mg/ kg , tion of the osteoclast inhibitor can improve the bioavailabil about 1 . 8 mg/ kg to about 2 mg/ kg , about 2 mg/ kg to about ity of the osteoclast inhibitor. 2 . 2 mg/ kg , about 2 . 2 mg/ kg to about 2 . 4 mg/ kg , about 2 . 4 The oral bioavailability of osteoclast inhibitor in a dosage mg/ kg to about 2 . 6 mg/ kg , about 2 . 6 mg/ kg to about 2 . 8 40 form can vary. Some dosage forms may have ingredients mg/ kg , about 2 . 8 mg/ kg to about 3 mg/ kg , about 3 mg/ kg to added to enhance the bioavailability . However, bioavailabil about 3 . 2 mg /kg , about 3 . 2 mg/ kg to about 3 . 4 mg/ kg , about ity enhancement is not necessary for an oral dosage form to 3 . 4 mg/ kg to about 3 . 6 mg/ kg , about 3 . 6 mg/ kg to about 3 . 8 be effective . In some embodiments , the dosage form is mg/ kg , about 3 . 8 mg/ kg to about 4 mg/ kg , about 4 mg/kg to substantially free of bioavailability - enhancing agents , such about 4 . 2 mg /kg , about 4 . 2 mg/ kg to about 4 . 4 mg/ kg , about 45 as amino acids or large quantities ( e . g . at least about 5 % , 4 . 4 mg/ kg to about 4 . 6 mg/ kg , about 4 . 6 mg/ kg to about 4 . 8 10 % , 20 % , 50 % , 70 % , or more ) of carboxylic acid salts . In mg/ kg , about 4 . 8 mg/kg to about 5 mg/ kg , about 5 mg/ kg to some embodiments , an oral dosage form may have an oral about 5 . 2 mg/ kg , about 5 . 2 mg/ kg to about 5 . 4 mg/ kg , about bioavailability of the osteoclast inhibitor — such as zole 5 . 4 mg/ kg to about 5 . 6 mg/ kg , about 5 . 6 mg/ kg to about 5 . 8 dronic acid , minodronic acid , ibandronic acid of about mg/ kg , about 5 .8 mg/ kg to about 6 mg/ kg , about 6 mg/ kg to 50 0 .01 % to about 10 % , about 0 . 1 % to about 7 % , about 0 . 1 % about 6 . 2 mg/ kg , about 6 . 2 mg /kg to about 6 . 4 mg/ kg , about to about 5 % , etc . Without ingredients or other methods to 6 . 4 mg/ kg to about 6 .6 mg/ kg , about 6 .6 mg/ kg to about 6 . 8 enhance bioavailability , bisphosphonates such as zoledronic mg/ kg , about 6 . 8 mg/ kg to about 7 mg/ kg , about 7 mg/kg to acid typically have a low bioavailability in an oral dosage about 7 . 2 mg/ kg , about 7 . 2 mg/ kg to about 7 . 4 mg/ kg , about form . In some embodiments , the oral bioavailability of 7 . 4 mg/ kg to about 7 . 6 mg/ kg , about 7 .6 mg /kg to about 7 . 8 55 zoledronic acid is unenhanced or substantially unenhanced . mg /kg , about 7 . 8 mg/ kg to about 8 mg/ kg , about 8 mg/ kg to For example , the oral bioavailability of zoledronic acid can about 8 . 2 mg/ kg , about 8 . 2 mg /kg to about 8 . 4 mg/ kg , about be about 0 .01 % to about 5 % , about 0 .01 % to about 4 % , 8 . 4 mg/ kg to about 8 . 6 mg/ kg , about 8 .6 mg/ kg to about 8 . 8 aut mg/ kg , about 8 . 8 mg/ kg to about 9 mg/ kg , about 9 mg/ kg to 0 . 2 % to about 2 % , about 0 . 2 % to about 1 . 5 % , about 0 . 3 % to about 9 . 2 mg/ kg , about 9 . 2 mg/ kg to about 9 . 4 mg/ kg , about 60 about 1 . 5 % , about 0 . 3 % to about 1 % , about 1 % to about 3 % , 9 .4 mg/kg to about 9. 6 mg/ kg , about 9 .6 mg/ kg to about 9. 8 about 1. 2 % to about 3 .5 % , about 1. 2 % to about 3 % , about mg/kg , about 9 . 8 mg/ kg to about 10 mg/ kg , about 0 .5 mg/ kg 1 % to about 4 % , about 1 . 5 % to about 4 . 5 % , about 0 . 1 % to to about 2 mg/ kg , about 0 .6 mg/ kg to about 2 mg /kg , about about 0 . 5 % , about 0 .3 % to about 0 .5 % , about 0 . 5 % to about 0 . 7 mg/ kg to about 2 mg/ kg , about 0 . 8 mg/ kg to about2 1 % , about 0 .6 % to about 0 . 7 % , about 0 . 7 % to about 0 . 8 % , mg/ kg , about 0 .5 mg/ kg to about 1. 5 mg /kg , about 0 .6 mg/ kg 65 about 0 .8 % to about 0 . 9 % , about 0 . 9 % , about 1 % to about to about 1 . 5 mg/ kg , about 0 . 7 mg/ kg to about 1 . 5 mg/ kg , 1 . 1 % , about 1 . 1 % to about 1 . 2 % , about 1 . 2 % to about 1 . 3 % , about 0 . 8 mg/ kg to about 1. 5 mg/ kg , about 0 . 5 mg/ kg to about 1 . 3 % to about 1 . 4 % , about 1. 4 % to about 1 .5 % , about US 10 ,016 ,446 B2 41 1 . 5 % to about 1 .6 % , about 1 .6 % to about 1 . 8 % , about 1 . 8 % three months, once every four months, once every five to about 2 % , about 2 % to about 2 . 2 % , about 2 . 2 % to about months, once every six months , once yearly , or once every 2 .4 % , about 2 . 4 % to about 2 .6 % , about 2 .6 % to about 2 .8 % , two years . about 2 .8 % to about 3 .0 % , about 3 % to about 3. 2 % , about In some embodiments , the oral zoledronic acid , mino 3 . 2 % to about 3 . 4 % , about 3 . 4 % to about 3 . 6 % , about 3 . 6 % 5 dronic acid , or ibandronic acid may be administered as one to about 3 . 8 % , about 3 . 8 % to about 4 % , about 2 % to about dose of about 100 mg to about 2000 mg . In some embodi 2 . 5 % , or any bioavailability of zoledronic acid in a range ments , the oral zoledronic acid , minodronic acid , or iban bounded by, or between , any of these values . dronic acid may be administered as one dose of about 300 One embodiment is a pharmaceutical composition com mg to about 1500 mg. In some embodiments , the oral prising an osteoclast inhibitor such as zoledronic acid , 1 zoledronic acid , minodronic acid , or ibandronic acid may be minodronic acid , or ibandronic acid wherein the oral bio administered as one dose of about 200 mg to about 1000 mg. availability of zoledronic acid in the dosage form is from The dose of zoledronic acid , minodronic acid , or ibandronic about 0 . 01 % to about 10 % . acid may be administered in a single or divided dose . In some embodiments , the oral bioavailability of the An osteoclast inhibitor , such as zoledronic acid , mino dronic acid , or ibandronic acid , may be formulated for oral osteoclast inhibitor in the dosage form is about 0 .01 % to administration , for example , with an inert diluent or with an about 5 % , about 0 . 1 % to about 7 % , about 0 . 1 % to about 5 % , edible carrier, or it may be enclosed in hard or soft shell about 0 . 1 % to about 3 % , about 0 .1 % to about 2 % , about gelatin capsules , compressed into tablets , or incorporated 0 . 2 % to about 2 % , about 0 . 2 % to about 1. 5 % , about 0 . 3 % to directly with the food of the diet. For oral therapeutic about 1 . 5 % , or about 0 . 3 % to about 1 . 0 % . administration , the active compound may be incorporated In some embodiments , the oral bioavailability of zole with an excipient and used in the form of ingestible tablets , dronic acid in the dosage form is about 0 .01 % to about 5 % . buccal tablets , coated tablets , troches , capsules , elixirs , In some embodiments, the oral bioavailability of zole dispersions , suspensions , solutions , syrups, wafers , patches , dronic acid in the dosage form is about 0 . 1 % to about 7 % . and the like . In some embodiments , the oral bioavailability of zole - 25 Tablets , troches , pills , capsules and the like may also dronic acid in the dosage form is about 0 . 1 % to about 5 % . contain one or more of the following : a binder such as gum In some embodiments , the oral bioavailability of zole tragacanth , acacia , corn starch or gelatin ; an excipient, such dronic acid in the dosage form is about 0 . 1 % to about 3 % . as dicalcium phosphate ; a disintegrating agent such as corn In some embodiments , the oral bioavailability of zole starch , potato starch , alginic acid and the like ; a lubricant dronic acid in the dosage form is about 0 . 1 % to about 2 % . 30 such as magnesium stearate ; a sweetening agent such as In some embodiments, the oral bioavailability of zole sucrose, lactose or saccharin ; or a flavoring agent such as dronic acid in the dosage form is about 0 . 2 % to about 2 % . peppermint, oil of wintergreen or cherry flavoring. When the In some embodiments , the oral bioavailability of zole unit dosage form is a capsule , it may contain , in addition to dronic acid in the dosage form is about 0 . 2 % to about 1 . 5 % . materials of the above type , a liquid carrier. Various other In some embodiments , the oral bioavailability of zole - 35 materials may be present as coating , for instance , tablets , dronic acid in the dosage form is about 0 . 3 % to about 1. 5 % . pills , or capsules may be coated with shellac, sugar or both . In some embodiments, the oral bioavailability of zole A syrup or elixir may contain the active compound , sucrose dronic acid in the dosage form is about 0 . 3 % to about 1 . 0 % . as a sweetening agent, methyl and propylparabens as pre In some embodiments , an oral dosage form comprises servatives , a dye and flavoring , such as cherry or orange about 10 mg to about 300 mg of zoledronic acid ,minodronic 40 flavor. It may be desirable for material in a dosage form or acid , or ibandronic acid and is administered daily for about pharmaceutical composition to be pharmaceutically pure 2 to about 15 consecutive days. This regimen may be and substantially non toxic in the amounts employed . repeated once monthly , once every two months , once every In some embodiments , an osteoclast inhibitor, including a three months , once every four months , once every five bisphosphonate , such as zoledronic acid . neridronic acid . months, once every six months, once yearly , or once every 45 etc . is in a dosage form containing one of, or a combination two years . In some embodiments , an oral dosage form comprises of, the ingredients in the Table E below . about 10 mg to about 150 mg or about 10 mg to about 100 mg of zoledronic acid , minodronic acid , or ibandronic acid TABLE E and is administered daily for about 2 to about 15 consecutive 50 Iron days . This regimen may be repeated once monthly , once Methyl Paraben Propyl Paraben every two months , once every three months, once every four Sorbitol months , once every five months , once every six months, Carob Bean Gum once yearly, or once every two years . Mannitol In some embodiments , an oral dosage form comprises 55 Gum Tragacanth Guar Gum about 10 mg to about 150 mg or about 10 mg to about 100 Benzoic Acid mg of zoledronic acid , minodronic acid , or ibandronic acid Sodium Benzoate and is administered daily for about 5 to about 10 consecutive Garlic and Oil of Garlic Oil of Rue days. This regimen may be repeated once monthly , once Propyl Gallate every two months , once every three months, once every four 60 Gum Ghatti months, once every five months , once every six months, Gum Arabic once yearly , or once every two years . Sterculia Gum (karaya gum ) Indian Dill Seed In some embodiments , an oral dosage form comprises Pulps about 40 mg to about 150 mg of zoledronic acid , minodronic Clove Bud Extract acid , or ibandronic acid and is administered daily for about 65 Clove Bud Oil 5 to about 10 consecutive days. This regimen may be Clove Bud Oleoresin repeated once monthly , once every two months , once every US 10 ,016 ,446 B2 43 44 TABLE E -continued TABLE E - continued Clove Leaf Oil Sodium aluminum phosphate , acidic Clove Stem Oil Sodium aluminum phosphate , basic Cholic acid Sodium phosphoaluminate Desoxycholic acid Beeswax ( yellow or white ) Glycocholic acid Japan wax Ox bile extract Carnauba wax Taurocholic acid Corn Sugar ( Dextrose ) Sorbose Corn Syrup Sodium thiosulfate Invert Sugar Gelatin 10 Inositol Mustard or Oil of Mustard ( Brown and Yellow ) Calcium stearate Glycyrrhiza Hydrogenated tallow Ammoniated Glycyrrhizin Stearic acid Licorice Tallow Caprylic Acid Malic acid Stannous Chloride L -Malic acid Ammonium bicarbonate Calcium sorbate Ammonium carbonate Potassium sorbate Ammonium chloride Sodium sorbate Ammonium hydroxide Sorbic acid Ammonium phosphate , such as ammonium phosphate dibasic or Sulfamic acid Ammonium phosphate monobasic Sodium hydrosulfite Ammonium sulfate 20 Zinc hydrosulfite Calcium iodate Tall oil Potassium iodate Fish oil, hydrogenated Potassium iodide Sucrose Aconitic Acid Agar- agar Calcium carbonate Ammonium alginate Potassium bicarbonate 25 Calcium alginate Sodium bicarbonate Potassium alginate Sodium carbonate Propylene glycol alginate Sodium sesquicarbonate Sodium alginate Glycerin and Glycerides Propylene Glycol Dextran Propylene glycol monostearate Dextrins 30 Brown algae Corn dextrins Red algae Calcium acetate Calcium glycerophosphate Calcium chloride Manganese glycerophosphate Calcium gluconate Magnesium glycerophosphate Calcium phytate Potassium glycerophosphate Calcium hydroxide Potassium hydroxide Calcium oxide 35 Sodium hydroxide Succinic acid Potassium metabisulfite Butylated Hydroxytoluene ( BHT) Sodium bisulfite Calcium hexametaphosphate Sodium metabisulfite Calcium phosphate dibasic Sodium sulfite Calcium phosphate monobasic Sulfur dioxide Calcium phosphate tribasic 40 Magnesium phosphate , dibasic Calcium pyrophosphate Magnesium carbonate Phosphoric acid Magnesium chloride Potassium phosphate dibasic Magnesium hydroxide Potassium phosphate monobasic Magnesium oxide Potassium phosphate tribasic Magnesium stearate Potassium polymetaphosphate 45 Magnesium sulfate Potassium pyrophosphate Magnesium phosphate , tribasic Potassium tripolyphosphate Adipic acid Sodium acid pyrophosphate Hydrogenated soybean oil Sodium hexametaphosphate Ethyl formate Sodium metaphosphate Formic acid Sodium phosphate dibasic 50 Sodium formate Sodium phosphate monobasic Carrageenan Sodium phosphate tribasic Nutmeg and Mace Sodium pyrophosphate , tetrabasic Zinc acetate Sodium tetrametaphosphate Zinc carbonate Sodium tetraphosphate Zinc chloride Sodium trimetaphosphate Zinc oxide Sodium tripolyphosphate 55 Zinc sulfate Sulfuric Acid Caramel alpha - Tocopherol acetate Lard Tocopherols Lard oil Choline Bitartrate Papain Choline Chloride Gum guaiac Aluminum ammonium sulfate 60 Coconut oil Aluminum hydroxide Linoleic acid Aluminum oleate Oleic acid Aluminum palmitate Peanut oil Aluminum potassium sulfate Calcium hypophosphite Aluminum sodium sulfate Manganous hypophosphite Aluminum sulfate 65 Potassium hypophosphite Sodium aluminate Sodium hypophosphite US 10 ,016 ,446 B2 45 46 TABLE E - continued TABLE E - continued Pectin , amidated Perlite ( filter aid ) Pectin , high ester Potassium silicate Pectin , low acid Silica aerogel Pectinates Silicon dioxides Pectinic acid Sodium aluminosilicate Carboxymethyl cellulose Sodium calcium aluminosilicate Cellulose acetate Sodium silicate Ethyl cellulose Talc (basic magnesium silicate ) Hydroxypropylmethyl cellulose Tricalcium silicate Methylcellulose 10 L ( + ) - potassium acid tartrate Sodium Carboxymethyl cellulose L ( + ) -sodium tartrate Rennet L ( + ) - tartaric acid Tannic acid (hydrolyzable gallotannins ) Manganous chloride Acetic acid Manganous citrate Sodium acetate Manganous gluconate Sodium diacetate Manganous oxide Pyridoxine Manganous sulfate Pyridoxine hydrochloride Lecithin Sodium oleate Lecithin , hydrogen peroxide bleached Sodium palmitate Riboflavin Ethyl acrylate , monomeric Riboflavin - 5 ' -phosphate Methyl acrylate , monomeric Calcium propionate Ethyl acrylate , polymeric 20 Dilauryl thiodipropionate Methyl acrylate , polymeric Propionic acid Bentonite Sodium propionate Clay ( kaolin ) Thiodipropionic acid Corn silk Hydrogen peroxide Ammonium citrate Carbon dioxide Calcium citrate 25 Nickel (elemental ) Citric acid Niacin (nicotinic acid ) Isopropyl citrate Niacinamide (nicotinamide ) Potassium citrate Carotene ( beta -carotene ) Sodium citrate L - Ascorbic acid Stearyl citrate Ascorbyl palmitate (palmitoyl L -ascorbic ) Triethyl citrate 30 Calcium L -ascorbate Biotin Erythorbic acid ( D - isoascorbic acid ) Enzymatically hydrolyzed casein Sodium erythorbate (sodium D - isoascorbate ) Acid hydrolyzed proteins Sodium L - ascorbate Enzymatically hydrolyzed protein Acetylated Distarch Adipate Soy sauces Acetylated Distarch Glycerol Yeast autolyzates Acetylated Distarch Phosphate Caffeine 35 Acetylated Distarch Oxypropanol L -Glutamic acid Acid Modified Starch L -Glutamic acid hydrochloride Arrowroot Starch Monoammonium L - glutamate Bleached Starch Monopotassium L - glutamate Cornstarch Monosodium L - glutamate Distarch Glycerol Calcium Lactate 40 Distarch Oxypropanol L ( + ) - calcium lactate Distarch Phosphate D ( - ) -Lactic acid High Amylose Cornstarch Lactic acid Hydroxypropyl Distarch Glycerol L ( + ) - lactic acid Hydroxypropyl Distarch Phosphate Butylated Hydroxyanisole ( BHA ) Hydroxypropyl Starch D - or DL - Calcium pantothenate 45 Hydroxypropyl Starch , oxidized D -Pantothenyl alcohol Milo Starch D - or DL - Sodium pantothenate Monostarch Phosphate Urea Potato starch Thiamine hydrochloride Pregelatinized starch Thiamine mononitrate Rice Starch Magnesium gluconate 50 Sodium Hydroxide Gelatinized Starch Potassium gluconate Starch Acetate Sodium gluconate Starch Aluminum Octenyl Succinate Zinc gluconate Starch Sodium Succinate Vitamin B12 ( cyanocobalamin ) Starch Sodium Octenyl Succinate Vitamin D2 ergocalciferol) Succinyl Distarch Glycerol Vitamin D3 ( cholecalciferol ) 55 Tapioca Starch Potassium chloride Waxy Maize Starch Sodium chloride Wheat Starch Soy protein isolate Phosphated Distarch Phosphate Hydrochloric acid Starch , Sodium Hypochlorite oxidized Copper (cupric ) gluconate Vitamin A Copper (cupric ) sulfate Vitamin A acetate Cuprous iodide 60 Vitamin A palmitate Calcium caseinate Diacetyl Casein Starter distillate Sodium caseinate Carbonyl Iron Aluminum calcium silicate Carbonyl Iron Calcium silicate Electrolytic Iron Diatomaceous earth ( filter aid ) 65 Electrolytic Iron Magnesium silicate Ferric ammonium citrate US 10 ,016 ,446 B2 47 48 TABLE E - continued or about 0 . 4 % (wt / wt ) to about 0 .6 % ( wt/ wt ) magnesium stearate may be present in an oral dosage form or a unit of Ferric chloride Ferric citrate an oral dosage form . Ferric oxide An oral dosage form comprising zoledronic acid or Ferric phosphate Ferric pyrophosphate 5 another bisphosphonate or osteoclast inhibitor may be Ferric sodium pyrophosphate included in a pharmaceutical product comprising more than Ferric sulfate one unit of the oral dosage form . Ferrous ascorbate A pharmaceutical product containing oral dosage forms Ferrous carbonate Ferrous citrate 10 for daily use can contain 28 , 29, 30 , or 31 units of the oral Ferrous fumarate dosage form for a monthly supply .An approximately 6 week Ferrous gluconate daily supply can contain 40 to 45 units of the oral dosage Ferrous lactate Ferrous sulfate form . An approximately 3 month daily supply can contain 85 Ferrous sulfate to 95 units of the oral dosage form . An approximately six Iron caprylate 15 month daily supply can contain 170 to 200 units of the oral Iron linoleate dosage form . An approximately one year daily supply can Iron naphthenate Iron oxides contain 350 to 380 units of the oral dosage form . Iron peptonate A pharmaceutical product containing oral dosage forms Iron polyvinylpyrrolidone for weekly use can contain 4 or 5 units of the oral dosage Iron tallate Sodium ferric EDTA 20 form for a monthly supply . An approximately two month Sodium ferricitropyrophosphate weekly supply can contain 8 or 9 units of the oral dosage Dietary Iron form . An approximately six week weekly supply can contain Ferric oxide Potassium carbonate about 6 units of the oral dosage form . An approximately Calcium glycerophosphate three month weekly supply can contain 12 , 13 or 14 units of Cellulose , such as microcrystalline cellulose 25 the oral dosage form . An approximately six month weekly Titanium dioxide supply can contain 22 to 30 units of the oral dosage form . An approximately one year weekly supply can contain 45 to 60 Some compositions or dosage formsmay be a liquid , or units of the oral dosage form . may comprise a solid phase dispersed in a liquid . A pharmaceutical product may accommodate other dos An osteoclast inhibitor , such as zoledronic acid , mino - 30 ing regimes . For example , a pharmaceutical product may dronic acid , or ibandronic acid may be formulated for comprise 5 to 10 units of the oral dosage form , wherein each parental or intraperitoneal administration . Solutions of the unit of the oral dosage form contains about 40 mg to about active compounds as free acids or pharmacologically accept- 150 mg of zoledronic acid , minodronic acid , or ibandronic able salts can be prepared in water suitably mixed with a 35 acid . Some pharmaceutical products may comprise 1 to 10 surfactant, such as hydroxypropylcellulose . A dispersion can units of the oral dosage form , wherein the product contains also have an oil dispersed within , or dispersed in , glycerol, about 200 mg to about 2000 mg of zoledronic acid , mino liquid polyethylene glycols , and mixtures thereof . Under dronic acid , or ibandronic acid . For such a product , each unit ordinary conditions of storage and use , these preparations of the oral dosage form may be taken daily for 1 to 10 days may contain a preservative to prevent the growth of micro - 40 or 5 to 10 days during a month , such as at the beginning of organisms. a month . In some embodiments , an oral dosage form may comprise Some oral dosage forms comprising an osteoclast inhibi a silicified microcrystalline cellulose such as PROSLOV® . tor — such as suitable bisphosphonates like zoledronic acid , For example , about 20 % (wt /wt ) to about 70 % (wt / wt ) , minodronic acid , or ibandronic acid or salts thereof may about 10 % (wt / wt ) to about 20 % (wt / wt ) , about 20 % (wt / wt) 45 have enteric coatings or film coatings. In some embodi to about 40 % (wt /wt ) , about 25 % (wt /wt ) to about 30 % ments , an oral dosage form of an osteoclast inhibitor com ( wt/wt ) , about 40 % (wt /wt ) to about 50 % (wt / wt ) , or about prises a tablet having an enteric coating . In some embodi 45 % (wt / wt ) to about 50 % (wt / wt ) silicified microcrystalline ments , an oral dosage form of an osteoclast inhibitor cellulose may be present in an oral dosage form or a unit of comprises a capsule having an enteric coating . In some 50 embodiments , an oral dosage form of an osteoclast inhibitor an oral dosage form . comprises a tablet having a film coating . In some embodi In some embodiments , an oral dosage form may comprise ments , an oral dosage form of an osteoclast inhibitor com a crosslinked polyvinylpyrrolidone such as crospovidone . prises a capsule having a film coating . For example , about 1 % (wt / wt) to about 10 % (wt / wt) , about Useful doses for an antibody against RANK or RANKL , 1 % (wt /wt ) to about 5 % (wt / wt ) , or about 1 % (wt / wt ) to 55 such as denosumab , may range from about 0 . 1 mg/ kg to about 3 % ( wt/ wt ) crosslinked polyvinylpyrrolidone may be about 20 mg /kg , about 0 .75 mg/ kg to about 7 . 5 mg /kg , about present in an oral dosage form or a unit of an oral dosage 0 . 1 mg/ kg to about 5 mg/ kg , about 1 mg/kg to about 2 form . mg/ kg , about 10 mg/ kg to about 20 mg/ kg , about 12 to about In some embodiments , an oral dosage form may comprise 17 mg/kg , about 15 mg/ kg to about 20 mg/ kg , about 1 a fumed silica such as AEROSIL® . For example , about 60 mg/ kg , about 1 mg/ kg to about 10 mg/ kg , or any value 0 . 1 % (wt /wt ) to about 10 % (wt /wt ) , about 0 . 1 % (wt / wt ) to bounded by or in between these ranges based on the body about 1 % ( wt/ wt ) , or about 0 . 4 % (wt / wt ) to about 0 . 6 % weight of the mammal. The chosen dose may be adminis ( wt/wt ) fumed silica may be present in an oral dosage form tered repeatedly , particularly for chronic conditions, or the or a unit of an oral dosage form . amount per dose may be increased or decreased as treatment In some embodiments, an oral dosage form may comprise 65 progresses . The chosen dose may be administered one or magnesium stearate . For example , about 0 . 1 % ( wt/ wt ) to more times per week , monthly , every two months, every about 10 % (wt / wt ) , about 0. 1 % (wt / wt ) to about 1 % (wt / wt ), three months, every six months, or every year. US 10 , 016 , 446 B2 49 50 In some embodiments , 60 mg of denosumab is adminis - Some oral dosage forms comprising zoledronic acid or a tered subcutaneously to patient in need of treatment. In some salt thereof may have enteric coatings or film coatings. embodiments , the administration is repeated every six In the examples below , zoledronic acid was administered months . in the disodium salt form as disodium zoledronate tetrahy There are a number of ways that some part of Compound 5 drate . No bioavailability enhancing agents were used in the 1 and / or Compound 2 may be removed from a zoledronic test compositions. acid product. For example , HPLC , preparative TLC , crys tallization , sublimation , or zone purification may be EXAMPLE 1 employed . Solvents that may be useful in HPLC , TLC , or crystallization , may include , but are not limited to , water or 10 Effect of Orally Administered Zoledronic Acid in organic solvents , such as hexanes, diethyl ether, ethyl Rat Model of Inflammatory Pain acetate , methyl acetate , acetone , acetic acid , acetonitrile , tetrahydrofuran , ethanol, methanol, isopropyl alcohol, chlo - Method : roform , diethyl ether, toluene, dimethylformamide , benzene , The effect of orally administered zoledronic acid on etc . Gradients, or two solvent systems may be employed as 15 inflammatory pain was examined using the rat complete well . For example , an HPLC separation may begin by Freund ' s adjuvant (CFA ) model . Inflammatory pain was elution with water , after some time eluting with water, an induced by injection of 100 % CFA in a 75 uL volume into organic solvent, such as acetonitrile, methanol, ethanol, the left hind paws of Sprague -Dawley® rats on day 0 , ethyl acetate , acetone , acetic acid ,methyl acetate , or another followed by assessments on days 1 - 3 . Animals were orally solvent could gradually be added to the water , or may 20 administered vehicle (control ) , zoledronic acid 18 mg/ m² (or replace the water entirely . Similarly , crystallization or 3 mg/ kg ) , zoledronic acid 120 mg/ m² (or 20 mg/ kg ) , or recrystallization may employ a single solvent, or a combi- zoledronic acid 900 mg/ m² (or 150 mg/kg ) daily on days nation of solvents . For example , zoledronic acid or a salt 1 -3 . Drug was dissolved in distilled water and prepared fresh thereof, such as a disodium salt, might be recrystallized from daily . Animals were fasted prior to dosing . Under current water, ethanol, methanol, diethyl ether, methyl acetate , ace - 25 FDA guidelines for extrapolating starting dosages from tic acid , etc ., or a combination of these solvents or others . In animals to humans , dosages expressed in mg/m² are con some embodiments , zoledronic acid or a salt thereof, such as sidered equivalent between mammalian species. Thus, for a disodium salt, may be dissolved in one solvent, such as example , 18 mg/m2 in a rat is considered equivalent to 18 water or acetic acid , and crystallized by a second solvent or mg/ m² in a human being , while 3 mg/ kg in a rat may not be solvent system , such as hexane , diethyl ether , chloroform , 30 equivalent to 3 mg/ kg in a human being . dichloromethane , ethyl acetate , methyl acetate , acetic acid , Values for inflammatory pain (mechanical hyperalgesia ) ethanol, methanol, or a combination thereof. In some in the vehicle and drug - treated animals were obtained on day embodiments , a disodium salt of zoledronic acid is dissolved prior to CFA injection , and at baseline and post -treatment in water, and then crystallized by adding hexane . In some on days 1 - 3 . Pain was assessed using a digital Randall embodiments , a disodium salt of zoledronic acid is dissolved 35 Selitto device (dRS ; IITC Life Sciences, Woodland Hills , in water, and then crystallized by adding diethyl ether. In Calif . ) . Animals were placed in a restraint sling that sus some embodiments , a disodium salt of zoledronic acid is pended the animal , leaving the hind limbs available for dissolved in water, and then crystallized by adding chloro - testing . Paw compression threshold was measured by apply form . In some embodiments , a disodium salt of zoledronic i ng increasing pressure to the plantar surface of the hind paw acid is dissolved in water, and then crystallized by adding 40 with a dome- shaped tip placed between the 3rd and 4th dichloromethane . In some embodiments , a disodium salt of metatarsus . Pressure was applied gradually over approxi zoledronic acid is dissolved in water , and then crystallized mately 10 seconds. Measurements were taken from the first by adding ethyl acetate . In some embodiments , a disodium observed nocifensive behavior of vocalization , struggle or salt of zoledronic acid is dissolved in water, and then withdrawal. A cut -off value of 300 g was used to prevent crystallized by adding methyl acetate . In some embodi- 45 injury to the animal. ments, a disodium salt of zoledronic acid is dissolved in Reversal of inflammatory pain was calculated according water , and then crystallized by adding acetic acid . In some to the formula : embodiments, a disodium salt of zoledronic acid is dissolved in water , and then crystallized by adding ethanol. In some reversal = ( Post- treatment - Post - CFA baseline ) ( Pre embodiments , a disodium salt of zoledronic acid is dissolved 50 CFA baseline - Post -CFA baseline )x100 . in water, and then crystallized by adding methanol. For The experiment was carried out using 9 - 10 animals per embodiments employing water and a second solvent, the group . ratio of water to the second solvent (water : second solvent ) Results : may be about 1 : 100 to about 100 : 1 , about 1 : 10 to about 1 : 5 , Oral administration of zoledronic acid significantly about 1 :5 to about 1 : 4 , about 1 : 4 to about 1: 3 , about 1 : 3 to 55 improved inflammatory pain thresholds compared to about 1 : 2 , about 1 : 2 to about 1 : 1 , about 1 : 1 to about 2 : 1 , vehicle . Pain threshold measurements taken at various times about 2 : 1 to about 3 : 1 , about 3 : 1 to about 4 : 1 , about 4 : 1 to are shown in FIG . 1 . Paw compression thresholds in the 18 about 5 : 1 , or about 1 : 1 to about 10 : 1 . mg/ m² group were higher than for vehicle during the entire In some embodiments, a combination of two methods measurement period after 30 minutes from the start of recited in the paragraph above may be employed , such as 60 treatment. On day three , paw compression thresholds for HPLC or TLC and crystallization . In some embodiments , a both the 18 mg/ m² and 900 mg/m² groups were greater than method may be repeated , such as HPLC , preparative TLC , for vehicle . An improvement in pain threshold of 49 % and crystallization , sublimation , or zone purification . In some 83 % from baseline was observed for the 18 mg/ m² and the embodiments , a purification method recited in the paragraph 900 mg/m² groups respectively . above may be performed twice . In some embodiments , a 65 Orally administered zoledronic acid produced a 29 % purification method recited in the paragraph above may be reversal of inflammatory pain at the 18 mg/m2 , and a 48 % performed three or four times . reversal at the 900 mg/ m² dose . This magnitude of effect is US 10 ,016 , 446 B2 51 52 comparable to that obtained with clinical doses of commer EXAMPLE 3 cially available NSAIDs when tested in a similar model of inflammatory pain . Under current FDA guidelines, the ref Treatment of Complex Regional Pain Syndrome erence body surface area of a human adult is 1 .62 m². Thus , with Orally Administered Zoledronic Acid a daily dose of 18 mg/ m² corresponds to a monthly dose of 5 about 500 -560 mg/ m ? or a human dose of about 800 - 900 mg. The effect of orally administered zoledronic acid was examined in the rat tibia fracture model of complex regional Surprisingly , the two higher doses resulted in thresholds pain syndrome (CRPS ) . CRPS was induced in the rats by that were lower than vehicle on the first two days of dosing . fracturing the right distal tibias of the animals and casting The 120 mg/ m² group was approximately equal or inferior 10 the fractured hindpaws for 4 weeks, as described in Guo T to vehicle at all time points during the assessment period . Z et al. (Pain . 2004 ; 108 : 95 - 107) . This animal model has While the 900 mg /m² group showed effectiveness on day 3 , been shown to replicate the inciting trauma (such as a this result was accompanied by significant toxicity necessi fracture , a surgery , a crushing injury , a cutting injury , a tating euthanization of all the animals in this group two days scratch , or a puncture injury ), natural history, signs, symp after cessation of dosing . 15 toms, and pathologic changes observed in human CRPS patients (Kingery W S et al. , Pain . 2003 ; 104 :75 - 84 ) . EXAMPLE 2 Animals were orally administered either vehicle ( control) or zoledronic acid , in a dosage of 18 mg/ m - /day ( 3 mg/ kg Effect of Orally Administered Zoledronic Acid in day ) for 28 days , starting on the day of fracture and casting . Rat Model of Arthritis Pain 20 Drug was dissolved in distilled water and administered by gavage . Animals were fasted for 4 hours before and 2 hours Method : after dosing. At the end of the 28 -day period , casts were The effect of orally administered zoledronic acid on removed , and on the following day , the rats were tested for arthritis pain was examined in the rat complete Freund 's hindpaw pain , edema, and warmth . adjuvant (CFA ) model of arthritis pain . In this model, 25 Pain Assessments injection of 100 % complete Freund ' s adjuvant (CFA ) in a 75 Pain was assessed by measuring hyperalgesia , and weight uL volume into the left hind paws is followed by a 10 - 14 day bearing . period to allow for the development of arthritis pain . Ani- To measure hyperalgesia , an up - down von Frey testing mals were orally administered vehicle ( control) , zoledronic paradigm was used . Rats were placed in a clear plastic acid 54 mg/ m² (or 9 mg/ kg ) , or zoledronic acid 360 mg/ m2 30 cylinder ( 20 cm in diameter ) with a wire mesh bottom and ( or 60 mg /kg ) , divided in three equal daily doses on the first allowed to acclimate for 15 minutes . The paw was tested three days post CFA injection . Drug was dissolved in with one of a series of eight von Frey hairs ranging in distilled water and prepared fresh daily . Animals were fasted stiffness from 0 . 41 g to 15 . 14 g . The von Frey hair was prior to dosing . applied against the hindpaw plantar skin at approximately Arthritis pain (mechanical hyperalgesia ) in the vehicle 35 midsole , taking care to avoid the tori pads . The fiber was and drug - treated animals was evaluated on day 14 post CFA pushed until it slightly bowed and then it was jiggled in that injection using a digital Randall -Selitto device (dRS ; IITC position for 6 seconds . Stimuli were presented at an interval Life Sciences , Woodland Hills , Calif . ) . Animals were placed of several seconds. Hindpaw withdrawal from the fiber was in a restraint sling that suspended the animal, leaving the considered a positive response . The initial fiber presentation hind limbs available for testing. Paw compression threshold 40 was 2 . 1 g and the fibers were presented according to the was measured by applying increasing pressure to the plantar up - down method of Dixon to generate six responses in the surface of the hind paw with a dome- shaped tip placed immediate vicinity of the 50 % threshold . Stimuli were between the 3rd and 4th metatarsus . Pressure was applied presented at an interval of several seconds . gradually over approximately 10 seconds . Measurements An incapacitance device ( IITC Inc . Life Science , Wood were taken from the first observed nocifensive behavior of 45 land , Calif ., USA ) was used to measure hindpaw weight vocalization , struggle or withdrawal. A cut- off value of 300 bearing , a postural effect of pain . The rats were manually g was used to prevent injury to the animal . held in a vertical position over the apparatus with the Reversal of arthritis pain in the ipsilateral (CFA - injected ) hindpaws resting on separate metal scale plates and the paw was calculated according to the formula : entire weight of the rat was supported on the hindpaws. The 50 duration of each measurement was 6 seconds and 10 con reversal = ( ipsilateral drug threshold - ipsilateral secutive measurements were taken at 60 - second intervals . vehicle threshold )/ (contralateral vehicle thresh Eight readings ( excluding the highest and lowest ones ) were old - ipsilateral vehicle threshold )x100 . averaged to calculate the bilateral hindpaw weightbearing The experiment was carried out using 7 -10 animals per values . Weight bearing data were analyzed as the ratio group . 55 between right ( fracture ) and left hindpaw weight bearing Results: values ( ( 2R / ( R + L ) ) x100 % ) . Oral administration of zoledronic acid significantly Edema Assessment improved arthritis pain thresholds compared to vehicle . As laser sensor technique was used to determine the shown in FIGS . 2A and 2B , orally administered zoledronic dorsal- ventral thickness of the hindpaw . Before baseline acid produced a dose - dependent reversal of arthritis pain . A 60 testing the bilateral hindpaws were tattooed with a 2 to 3 mm reversal of 33 % was observed in the 54 mg/m² group , and spot on the dorsal skin over the midpoint of the third reversal of 54 % was observed in the 360 mg/m² group . metatarsal . For laser measurements each rat was briefly Under current FDA guidelines , the reference body surface anesthetized with isoflurane and then held vertically so the area of a human adult is 1 .62 m². Thus , 54 mg /m² in a rat is h indpaw rested on a table top below the laser. The paw was equivalent to an implied human dose of about 87 mg, and 65 gently held flat on the table with a small metal rod applied 360 mg/m2 in a rat is equivalent to an implied human dose to the top of the ankle joint. Using optical triangulation , a of about 583 mg. laser with a distance measuring sensor was used to deter US 10 ,016 ,446 B2 53 54 mine the distance to the table top and to the top of the EXAMPLE 5 hindpaw at the tattoo site and the difference was used to calculate the dorsal- ventral paw thickness . The measure Bioavailability of Orally Administered Zoledronic ment sensor device used in these experiments (4381 Preci Acid and Disodium Zoledronate cura , Limab , Goteborg , Sweden ) has a measurement range 5 of 200 mm with a 0 .01 mm resolution . Tablets were manufactured containing either pure zole Hindpaw Temperature Measurement dronic acid or the disodium salt of zoledronic acid ( disodium The temperature of the hindpaw was measured using a zoledronate tetrahydrate ). Both types of tablets contained 50 fine wire thermocouple (Omega , Stanford , Conn ., USA ) mg of zoledronic acid equivalent per tablet . Identical excipi applied to the paw skin . Six sites were tested per hindpaw . Vents" were used in both types of tablets, with amounts The six measurements for each hindpaw were averaged for adjusted to account for the difference in molecular weights the mean temperature . between the acid and the disodium salt. Results Beagle dogs were orally administered tablets containing As illustrated in FIG . 3 , treatment with orally adminis - 15 150 mg zoledronic acid equivalent either in the form of tered zoledronic acid reversed pain , restored weight bearing, disodium zoledronate (Group 1) or pure zoledronic acid and prevented edema as compared to vehicle treated ani (Group 2 ) . Each animal was given three 50 mg equivalent mals . tablets ( 150 mg total) , which were administered together . As illustrated in FIG . 4 , von Frey pain thresholds for the The animal' s oral cavity was wetted with water before right ( fracture ) hindpaw were reduced by 72 % versus the 20 placing the tablets on the back of the animal' s tongue . contralateral (normal ) hindpaw in vehicle treated animals . Animals were fasted before and after dosing . Animals were Zoledronate treatment reversed fracture induced pain by 6 to 9 months of age and weighed 6 to 10 kg on the day of 77 % as compared to vehicle treatment. dosing . There were three dogs per group . As illustrated in FIG . 5 , reduction in weight bearing , a Serial blood samples were collected from each animal by postural effect of pain , was significantly higher in the vehicle 25 venipuncture of the jugular vein at various points after treated group as compared to the zoledronic acid treated dosing for measurement of plasma concentrations of zole group . Weight bearing on the fracture hindlimb was reduced dronic acid . Blood samples were collected into chilled tubes to 55 % of normal in the vehicle treated group . Zoledronate containing K EDTA as the anticoagulant. Samples were treatment significantly restored hindlimb weight bearing as then centrifuged at approximately 3000 rpm at + 4° C . for 10 compared to vehicle treatment ( 86 % of normal ) . 30 minutes for plasma derivation . Plasma concentrations of As illustrated in FIG . 6 , the expected increase in hindpaw zoledronic acid were measured using an LC /MS / MS thickness was greater in the vehicle treated group as com methodResults . pared to the zoledronic acid treated group , reflecting the The average plasma concentrations of zoledronic acid for development of edema. Zoledronate treatment reduced hind - 35 each group of dogs is summarized in Table 1 and illustrated paw edema by 60 % versus vehicle treatment. in FIG . 8 . Detectable plasma levels of zoledronic acid were Zoledronic acid reduced hindpaw warmth by 5 % versus observed for the entire 48 hours that they were measured . vehicle treatment . The daily dose in the above experiment was 18 mg/ m² / TABLE 1 day . Under current FDA guidelines , the reference body 40 - surface area of a human adult is 1 .62 m2. Thus, a daily dose Zoledronic Acid plasma concentrations in beagle dogs of 18 mg/m2 corresponds to a monthly dose of about Plasma 500 - 560 mg/ m ? or a human dose of about 800 - 900 mg. Time concentration (hour ) (ng /mL ) EXAMPLE 4 45 Group 1 (N = 3) Disodium Zoledronate 0 0 .00 Tablets 0 .25 1193. 97 (150 mg acid equivalent) 0 . 5 1852 . 12 Solubility of Disodium Salt of Zoledronic Acid 0 . 75 1776 .51 1626 . 56 The aqueous solubility of zoledronic acid and disodium 640 .57 136 .93 zoledronate tetrahydrate was determined . One gram of the 50 53. 11 test compound was measured in to a beaker. Demineralized 26 .97 water (pH 5 .5 ) was then added in small increments to the test 13 . 74 compound , and sonication was applied to the mixture . The ANTON 6 . 78 5 . 39 procedure was continued until complete dissolution was 55 Group 2 ( N = 3 ) Zoledronic Acid Tablets 0 . 00 achieved . Full dissolution was determined to have been » (150 mg acid equivalent) 0 . 25 390 .92 reached when a clear solution was present with no visible 0 . 5 846 . 19 0 . 75 819 . 15 material. The volume of water required to reach full disso 831 .77 lution was used to calculate a solubility value expressed in 477 . 76 grams per 100 mL . The procedure was performed for each 90 . 11 compound . 28. 22 15 . 10 Results 6 .13 As shown in FIG . 7 , the aqueous solubility of disodium 3 . 18 zoledronate tetrahydrate is approximately 50 times that of ?? 1 . 84 zoledronic acid . Disodium zoledronate tetrahydrate has a 65 solubility of 12 . 5 g / 100 mL compared to only 0 .25 g / 100 mL Disodium zoledronate produced significantly higher for zoledronic acid . plasma levels of zoledronic acid than pure zoledronic acid , US 10 ,016 ,446 B2 55 56 indicating improved oral absorption with the salt form . narrowing (JSN ) , which was graded according to the Measured using peak plasma concentrations (Cmar ) , the Osteoarthritis Research Society International (OARSI ) atlas . disodium salt resulted in a 119 % actual and 74 % weight Patients had either no joint space narrowing (OARSI Grade adjusted increase in bioavailability as compared to pure 0 ) , or greater degrees of joint space narrowing (OARSI zoledronic acid . Measured using area under the plasma 5 Grade 1 and Grade 2 ) . Twenty six patients were treated with concentration curve (AUCO . . . ), bioavailability was 84 % and zoledronic acid ( 8 , 6 , and 12 with OARSI Grades 0 , 1 , and 46 % greater with the disodium salt than with pure zole - 2 , respectively ). Twenty six patients received placebo (8 , 8 , dronic acid , on an actual and weight -adjusted basis respec - and 10 with OARSI Grades 0 , 1 and 2 , respectively ) . tively. The average AUCO. for the disodium salt was 4073 Pain intensity was assessed , at baseline and at three ng- h /mL and the average AUCO- for the diacid was 2217 10 months, using a 100 mm visual analog scale (VAS ) , with ng- h /mL . The AUC .. . was found to be dose proportional . zero representing no pain and 100 representing extreme Thus, for beagle dogs similar to those tested , about 3 mg to pain . The change in pain intensity from baseline to 3 months about 4 mg of the disodium salt would be expected to result was calculated . in an AUC of about 100 ng. h /mL , and about 7 mg to With zoledronic acid treatment, pain was reduced signifi about 8 mg of the disodium salt would be expected to result 15 cantly as compared to placebo in patients with no joint space in an AUC . .. of about 200 ng- h /mL . narrowing (OARSI Grade 0 ), but not in patients with joint space narrowing (OARSI Grades 1 - 2 ) . As shown in Table 3 EXAMPLE 6 and FIG . 10 , average VAS scores were reduced by 15 mm as compared to placebo in the OARSI Grade ( group , but Hardness of Tablets Comprising Zoledronic Acid in 20 only byhy 0o .28 28 as compared to placebo in patients with OARSI the Free Acid and Disodium Salt Forms Grades 1 - 2 . In the zoledronic acid group , average VAS scores at 3 Tablets were prepared by blending zoledronic acid , either months decreased from baseline by approximately 25 mm in the form of the free acid or the disodium salt, with and 21 mm in patients with OARSI Grades 0 and 1 , identical excipients . For dosage forms with a greater amount 25 respectively, but only by 9 mm in the OARSI Grade 2 of active , the amount of the excipients was reduced proporpropor - patients (FIG . 11 ) . tionally to keep the weight of the tablet at about 100 mg . After blending , the ingredients were compressed at varying pressures, followed by a film coating . The resulting tablets TABLE 3 were then tested for hardness using a Dr. Schleuniger 30 Change in VAS Pain Scores at Three Months by OARSI Grade (mm ) Pharmatron SM Tablet Hardness Tester. The results are shown in Table 2 and FIG . 9 . OARSI Grade 0 OARSI Grades 1 - 2 Zoledronic Acid - 24 . 6 - 13 . 2 TABLE 2 Placebo - 9 . 6 - 12 . 9 26 Difference from Placebo - 15 . 0 - 0 .28 Hardness (kPa ) 35 D Compression Disodium Disodium With zoledronic acid treatment, pain was reduced signifi Force Diacid Salt Salt cantly as compared to placebo in patients with baseline VAS (psi ) 50 mg 50 mg 71 mg pain intensity scores of 50 mm or greater , but not in patients 800 4 . 0 8 . 7 4 . 8 40 with baseline VAS scores less than 50 mm . As shown in 1100 6 . 1 11. 2 6 . 8 Table 4 , average VAS scores were reduced by 9 mm as 1500 7 .7 13 . 7 7 . 4 compared to placebo in the patients with baseline VAS250 2000 8 . 7 16 . 3 10 . 7 mm , but only by 0 . 6 as compared to placebo in patients with 2400 8. 7 11. 3 3000 11 .4 14 . 1 baseline VAS < 50 mm . 4400 12 . 5 14 . 9 45 5500 12 . 8 18 . 2 TABLE 4 6100 13 . 0 Change in VAS Pain Scores at Three Months by Baseline VAS (mm ) Baseline EXAMPLE 7 50 VAS 250 mm Baseline VAS < 50 mm Zoledronic Acid - 26 . 2 - 7 . 3 Effects of Zoledronic Acid on Patients with Placebo - 17 . 2 - 6 . 7 Osteoarthritis and BML Difference from Placebo - 9 .0 - 0 . 6 Some embodiments related to joint pain , bone marrow 55 As summarized in Table 5 and illustrated in FIG . 12 , pain lesions, and osteoarthritis were conceived as a result of reduction was greater in patients with baseline VAS > 50 mm , analyzing data from a clinical study . Some of the results of greater still in patients with OARSI Grade ( joint space this study were reported by Laslett et al. in Ann Rheum Dis narrowing , and greatest in patients with both baseline 2012 ; 71 : 1322 - 1328 . Some of the description and data VAS250 mm and OARSI Grade 0 joint space narrowing . reported below was not published prior to filing the present 60 application . Fifty - two (52 ) patients with clinical knee TABLE 5 osteoarthritis and knee bone marrow lesions ( BML ) were Pain Reduction Compared to Placebo at Three Months (mm ) randomized to receive either intravenous zoledronic acid (5 mg ) or placebo in a double blind fashion . All patients had to VAS Change have at least one bone marrow lesion (BML ) in the affected 65 All patients - 4 . 8 knee on magnetic resonance imaging (MRI ) . All patients Baseline VAS 250 mm - 9 . 0 had x - ray of the knee for determination of joint space US 10 ,016 ,446 B2 57 58 TABLE 5 - continued medication and hospital admissions were recorded . Blood samples were taken for the assessment of safety , inflamma Pain Reduction Compared to Placebo at Three Months (mm ) torymediators and markers of bone turnover at baseline , one VAS Change month and one year. Clinical assessments were performed 14 days before OARSI Grade 0 - 15 . 0 enrolment (screening visit ) , and follow -up visits at one Baseline VAS 250 mm + OARSI Grade 0 - 19 . 4 month and one year after the infusion . The primary outcome was the change in the intensity of LBP on VAS. Secondary BMLs were evaluated using proton density -weighted fat outcomes included leg pain intensity , ODI, health - related saturation MR images . BMLs were scored using Osiris 10 quality of life assessed with RAND - 36 , patient - reported sick software (University of Geneva , Geneva , Switzerland ). The leaves and lumbar flexibility . These outcome measures were maximum size was measured in mm? using software cursors assessed at baseline and at each follow - up . Lumbar flexibil applied to the greatest area of each lesion . The lesion with ity was evaluated using the fingers - to - floor and trunk side the highest score was used if more than one was present at bending measures ( in cm ) . The percentage of patients under the same site . Each patient was given a BML score (mm ) 15 going a 20 % relative improvement, the proportion of at each of the four sites (medial tibial, medial femoral, lateral patients reaching a VAS score of 40 or less in the primary tibial, and lateral femoral sites) and these were summed to outcome, and patient acceptable symptom state (PASS ) were create a total BML score (mm ” ) . The change in the total area also assessed . Pain medication use was inquired about of BMLs from baseline to 6 months was calculated . during the follow -up visits . The size of BMLs was reduced with zoledronic acid 20 ResultsRes treatment. As shown in FIG . 13 and Table 6 , average BML Zoledronic acid treatment resulted in a greater improve area decreased by approximately 190 mm ? as compared to ment in LBP intensity at one month as compared to placebo placebo in the OARSI Grade ( group , but only by approxi treatment. Furthermore , the patients receiving zoledronic mately 33 mm ? as compared to placebo in patients with os acid reported NSAID use at one year significantly less often OARSI Grades 1 - 2 . than those in the placebo group . Overall , the improvements in most of the evaluated parameters were greater in the TABLE 6 zoledronic acid group throughout the follow - up period . Change in BML Size (mm² ) The clinical characteristics of study participants at base line are displayed in Table 6 . The mean LBP duration was OARSIGrade O OARSI Grades 1 - 2 30 293 days , initial LBP intensity on VAS 6 . 7 , leg pain on VAS Zoledronic Acid - 244 - 117 2 . 9 and the ODI score was 32 % . Altogether 19 patients in the Placebo - 55 - 84 ZA group and 18 in the placebo group had a M1/2 lesion . Difference from Placebo - 190 - 33 Modic changes were most commonly ( 70 % ) situated at L4 /5 25 or L5 /S1 . The zoledronic acid and placebo groups were similar as regards the demographic and background charac teristics of all patients at baseline ( Table 6 ) . EXAMPLE 8 The mean difference (MD ) between the treatment groups Methods in the primary outcome, intensity of LBP , significantly A study was performed to evaluate the efficacy of a single 40 favored zoledronic acid at one month (MD 1. 4 ; 95 % CI 0 .01 intravenous infusion of 5 mg ZA in comparison with intra - to 2 . 9 ) while at one year no significant difference was venous placebo infusion among patients with chronic low observed (MD 0 . 7 ; 95 % CI- 1 . 0 to 2 .4 ; Table 7 ) . The pro back pain ( LBP ) and Modic changes on MRI. This study was portion of patients with at least 20 % improvement in inten a double -blinded , randomized , placebo -controlled clinical sity of LBP and PASS both favored the zoledronic acid trial in patients with low back pain (LBP ) . Patients were 45 treatment at one month : zoledronic acid 55 % vs . placebo included in the study if they had low back symptoms for at least three months, a LBP of at least six (6 ) on a 10 - cm 25 % ( p = 0 . 105 ) and zoledronic acid 50 % vs . placebo 20 % Visual Analog Scale (VAS ) or an Oswestry Disability Index (p = 0 .096 ), respectively . (ODI ) of at least 30 % , and an M1, mixed M1/ 2 or M2 type For the patients who were treated with zoledronic acid . change on MRI performed within six months at most prior 50 "the reduction in pain intensity was greater in those with to enrolment. greater baseline pain intensity as shown in Table 9 . The Patients were excluded from the study if they had renal mean reduction in pain from baseline was 3 .4 for patients impairment with reduced creatinine clearance defined as an with baseline pain intensity 27 , as compared to a reduction estimated glomerular filtration rate ( eGFR ) below ml/min , of only 0 . 1 for patients with a baseline pain intensity < 6 . hypocalcemia , known hypersensitivity to zoledronic acid or 55 Of the secondary outcomes , the improvement in ODI, other bisphosphonates or ingredients of the infusion product , favored zoledronic acid at 1 month , the adjusted between the presence of red flags , nerve root entrapment or willing group difference being 6 . 0 % ( 95 % CI - 0 .6 to 13 ) , but not at ness for early retirement. Premenopausal women of child one year ( Table 7 ) . Similarly , side bending ( to right and left ) bearing potential were also excluded . Blood samples were favored the zoledronic acid treatment at one month but not taken prior to the infusion to assess the serum concentration wat60 a one year ( Table 7 ) . Changes in totalRAND - 36 , and in the of calcium and creatinine . The clinical examination included physical and mental components of RAND - 36 are shown in medical history and clinical assessment of lumbar flexibility , Table 8 . tendon signs , and motor and sensory testing . At baseline , there were no differences in self -reported use After confirmation of eligibility patients were randomized of non -steroidal anti - inflammatory drugs (NSAIDs ) between to receive a single intravenous infusion of 5 mg zoledronic 65 the treatment groups, whereas at one year, only 20 % of acid ( n = 20 ) or 100 ml saline as placebo ( n = 20 ) over a patients in the ZA group used NSAIDs versus 60 % in the 15- minute period . Information on use of the concomitant placebo group . US 10 ,016 ,446 B2 59 60 TABLE 6 Baseline characteristics of study population according to treatment group

Zoledronic Acid Pacebo Characteristics n = 20 n = 20 Sex , n ( % ) men 15 (75 ) 11 (55 ) Age , mean ( SD ) years 49 ( 9 . 3 ) 51 ( 7 . 3 ) Smoking, n ( % ) regular smokers * 5 ( 25 ) 6 ( 30 ) BMI, mean ( SD ) kg/ m 26 ( 3 . 3 ) 27 ( 3 . 2 ) Workload , n ( % ) Sedentary work with limited walking 4 (20 ) 4 (22 ) Fairly light work with considerable walking but 4 ( 20 ) 3 ( 17 ) no lifting or carrying heavy objects Fairly strenuous work with walking and lifting 8 ( 40 ) heaving objects or climbing stairs or uphill 6 (33 ) Very strenuous work with lifting or carrying 4 ( 20 ) 5 (28 ) heaving objects such as shoveling, digging , or hammering Type of worst MC- lesion * * , n Type I Type I / II 19 18 Type II MC at two or more levels, n ( % ) 7 ( 3 . 5 ) 4 ( 20 ) Levels of MC , n L2 / 3 L3/ 4 L4 / 5 tmo uno L5 / s1 10 Duration of LBP , median (IQ range ) days 330 ( 200 , 365 ) 315 (270 , 365 ) Intensity of LBP , mean (SD ) * * * 6 . 6 ( 1 . 4 ) 6 . 8 ( 1 . 6 ) Duration of leg pain , median (IQ range ) days 50 ( 0 , 100 ) 36 ( 0 , 160 ) Intensity of leg pain , mean (SD )* * * 3 . 0 ( 3 . 1 ) 2 . 9 ( 2 . 3 ) Oswestry Disability Index , % , Mean (SD ) 30 ( 11) 35 (10 ) Duration of sick leave during the past year , 14 ( 0 , 48 ) 18 (1 , 181) median (IQ range ) days RAND - 36 , mean ( SD ) 50 ( 8 ) 50 ( 7 ) RAND - 36 physical component, mean (SD ) 51 ( 8 ) 49 ( 8 ) RAND - 36 mental component , mean (SD ) 51 ( 8 ) 49 ( 9 ) BMI = Body Mass Index , MC = Modic Change , LBP = low back pain , SD = standard deviation , IQ = inter - quartile . * Smoking at least one cigarette per day . * * If different types of MC at two or more levels , classification is based on the assumed severity of the type, i . e . , Type I > mixed Type I/ II > Type II . * * * Assessed using a 10 cm Visual Analogue Scale (VAS ) . TABLE 7 Low back symptoms and lumbar flexibility at baseline , one month and 12 months according to treatment group and between group comparisons of difference from baseline to one month and 12 months Mean ( SD ) original Unadjusted Adjusted values _ Mean (SD ) analyses analyses ZA Placebo change Difference Difference n = 20 n = 20 ZA Placebo (95 % CI) P (95 % CI) P * Intensity of LBP Baseline 6 .6 ( 1. 4 ) 6 . 8 ( 1. 6 ) 1 mo. 4 . 3 ( 2 . 3 ) 5 . 8 ( 2 . 2 ) - 2 . 2 - 0 . 9 1 . 3 0 . 097 1 . 4 0 .049 ( 2 .7 ) ( 2. 1 ) (- 0 . 2 to ( 0 .01 to 2 . 8 ) 2 . 9 ) 12 mos . 3. 8 (2 .5 ) 4 .6 (2 . 9 ) - 2. 8 - 2 . 2 0 .6 0 .474 0 . 7 0 . 387 ( 2 . 9 ) ( 2 . 5 ) ( - 1 . 1 to ( - 1 . 0 to Intensity of leg paina 2 . 4 ) 2 . 4 ) Baseline 3 . 0 ( 3 . 1 ) 2 . 9 ( 2 . 3 ) 1 mo. 2 .0 ( 2 . 3) 3 .0 (2 .4 ) - 0 .6 0 . 1 0. 8 0 .367 0. 8 0 .237 ( 2 . 4 ) ( 2 . 6 ) ( - 0 . 9 to ( - 0 . 6 to 2 . 4 ) 2 . 2 ) US 10 ,016 , 446 B2 62 TABLE 7 - continued

Low back symTIPLOIllu toms andall lumbar Hexibilityility at baseline , one month and 1212 months according to treatment group and between group comparisons of difference from baseline to one month and 12 months Mean ( SD ) original Unadjusted Adjusted values Mean (SD ) analyses analyses ZA Placebo change Difference Difference n = 20 n = 20 ZA Placebo ( 95 % CI) P ( 95 % CI) P * 12 mos . 2. 1 (2 . 8 ) 2 .7 (2 .6 ) -0 .9 - 0 .3 0. 6 0 .573 0 .5 0. 573 ( 3 . 4 ) ( 3 . 0 ) ( - 1 . 5 to ( - 1 . 3 to 2. 7 ) 2 . 2 ) Oswestry disability index, % Baseline 30 ( 11 ) 35 ( 10 ) 1 mo. 24 ( 10 ) 33 ( 13) - 5 . 9 - 1 .7 4 . 3 0 .212 6 . 0 0 .071 ( 11 ) ( - 2 . 5 to ( - 0 . 6 to 11 ) 13 ) 12 mos . 25 ( 13 ) 33 ( 15 ) - 5 . 0 - 1 . 9 3 . 1 0 .475 5 . 1 0 . 231 ( 15) (12 ) (_ - 56 5 . 6 toto ?( - 3. 4 to 12) 14 ) Fingers - to - floor, cm Baseline 23 ( 19 ) 19 ( 18 ) 1 mo. 17 (17 ) 19 (17 ) - 5. 1 - 0 . 1 5 . 0 0 . 306 3 .6 0 . 403 Baseline 13019 (20 ) ( 8 . 3 ) ( - 4 . 8 to ( - 5 . 0 to 15 ) 12) 12 mos. 16 ( 16 ) 20 ( 19 ) -6 .3 0 . 9 7 . 1 0 .215 5 .3 0 . 277 (23 ) ( 11) (- 4 .3 to ( - 4 . 5 to 18 ) 15 ) Sidebending to right, cm Baseline 14 . 1 ( 4 . 9 ) 13 . 8 ( 7 . 2 ) 1 mo. 15 .7 (5 . 9 ) 13. 3 ( 6 . 9 ) 1. 5 - 0 . 5 - 2 . 0 0 . 101 - 2 . 0 0 .087 ( 4 . 7 ) ( 2 . 2 ) ( -- 4 .. 3 to ( - 4 . 4 to 0 . 4 ) 0 . 3 ) 12 mos . 15 . 7 ( 5 . 6 ) 13 . 8 (6 . 5 ) 1 . 6 - 0 . 1 - 1 . 6 0 .227 - 1 . 7 0 . 180 ( 4 . 8 ) ( 3 . 5 ) ( - 4 . 3 to ( - 4 . 2 to 1 . 1 ) 0 . 8 ) Sidebending to left , cm | Baseline 15 . 0 ( 5 . 4 ) 13 . 3 (5 . 5 ) 1 mo. 16 . 1 ( 5 . 3 ) 12 . 8 ( 5 . 9 ) 1 . 1 - 0 . 5 - 1 . 5 0 .072 - 1 . 7 0 .051 ( 3 . 0 ) ( - 3 . 2 to ( - 3 . 4 to 0 . 1 ) 0 . 0 ) 12 mos. 16 . 2 (6 .7 ) 13 . 7 (5 . 7 ) 1 . 2 0 .5 - 0 . 1 0 .601 - 1. 0 0 . 458 ( 5 . 3 ) (3 . 2 ) ( - 3 . 5 to ( - 3 . 8 to 2 . 1 ) 1 . 8 ) SD = standard deviation , CI = confidence interval, ZA = zoledronic acid , LBP = low back pain . * ANCOVA : Difference between follow - up and baseline, treatment effect adjusted for baseline value . " One subject missing at baseline in placebo group and in ZA group , and one subject at 1 month in ZA group .

TABLE 8 Health - related quality of life assessed using RAND - 36 at baseline , one month , and 12 months according to treatment group and between group comparisons of difference from baseline to one month and 12 months Mean (SD ) Unadjusted Adjusted original values Mean (SD ) analyses analyses ZA Placebo change Difference Difference n = 20 n = 20 ZA Placebo ( 95 % CI) P (95 % CI) p * Total RAND - 36 Baseline 50 ( 8) 50 (7 ) 1 mo . 51 ( 8 ) 49 ( 8 ) 0 . 6 - 0 .6 1. 2 ( - 3 to 0 .530 1 . 3 ( - 3 to 0 .477 (6 . 4 ) ( 5 . 0 ) 5 ) US 10 ,016 ,446 B2 63 64 TABLE 8 -continued Health - related quality of life assessed using RAND - 36 at baseline , one month , and 12 months according to treatment group and between group comparisons of difference from baseline to one month and 12 months Mean (SD ) Unadjusted Adjusted _ original values Mean (SD ) analyses analyses ZA Placebo change Difference Difference n = 20 n = 20 ZA Placebo (95 % CI) P ( 95 % CI) P * 12 mos . 51 ( 8 ) 49 ( 9 ) 1 . 0 - 1 . 0 2 . 1 ( - 3 to 0 . 378 2 . 2 ( - 2 to 0 .314 ( 8 . 7 ) ( 5 . 9 ) 7 ) Physical component Baseline 52 ( 8 ) 48 (8 ) 1 mo. 52 ( 9 ) 48 ( 8 ) 0 . 1 - 0 . 1 0 . 3 ( - 4 to 0 .897 1 . 3 ( - 3 to 0 . 554 ( 8 .6 ) ( 5 . 5 ) 5 ) 6 ) 12 mos. 52 ( 8 ) 48 ( 2 ) 0 . 3 - 0 . 3 0 . 7 ( - 5 to 0 .808 2 . 1 ( - 3 to 0 .405 ( 10 ) ( 6 . 5 ) 6 ) Mental component Baseline 49 ( 9 ) 51 ( 8 ) 1 mo . 50 ( 9 ) 50 ( 9 ) 1. 0 - 1. 0 2 .0 (- 2 to 0. 286 1. 6 (- 2 to 0. 396 ( 6 . 1 ) ( 5 . 6 ) 6 ) 5 ) 12 mos. 51 ( 9 ) 49 ( 9 ) 1 . 8 - 1 .8 3 . 5 ( - 2 to 0 . 167 2 .7 (- 2 to 0 .261 (9 . 0 ) (6 . 7 ) 9) SD = standard deviation , CI = confidence interval, ZA = zoledronic acid . * ANCOVA : Difference between follow - up and baseline, treatment effect adjusted for baseline value .

TABLE 9 30 dronic acid , a dose of 21 mg/ kg on the first day and 3 Pain Reduction in Patients Treated Zoledronic Acid ( cm ) mg/ kg / day daily thereafter, or distilled water for 3 weeks VAS Change from (weeks 4 - 7 post - fracture ). Drug was dissolved in distilled Baseline water and administered by gavage . Animals were fasted for 35 Baseline VAS < 6 - 0 . 1 4 hours before and 2 hours after dosing . At the end of the Baseline VAS 26 and < 7 - 2 . 3 Baseline VAS 27 - 3 . 4 21 -day period , casts were removed , and on the following day , the rats were tested for hindpaw pain , edema, and 40 warmth . EXAMPLE 9 Results Methods : As illustrated in FIGS . 14 -15 , treatment with orally A study was performed to evaluate the efficacy of bis - administered zoledronic acid reversed pain and restored phosphonates such as oral zoledronic acid in inhibiting 45 weight bearing as compared to the vehicle treated animals . immune responses and pain behavior in a rat fracture model A s illustrated in FIG . 14 , von Frey pain thresholds for the of CRPS . right ( fracture) hindpaw were reduced by over 100 % as The effect of orally administered zoledronic acid was so compared to baseline when oral zoledronic acid was admin examined in the rat tibia fracture model of complex regional istered pain syndrome (CRPS ) . CRPS was induced in the rats by As illustrated in FIG . 15 , reduction in weight bearing , a fracturing the right distal tibias of the animals and casting postural effect of pain , was significantly higher in the vehicle the fractured hindpaws for 4 weeks, as described in Guo T 55 treated group as compared to the zoledronic acid treated Zet al ( Pain 2004 . 108 . 05 - 107 ) This animal model has group . Weight bearing on the fracture hindlimb was reduced to about 80 % of normal in the vehicle treated group . been shown to replicate the inciting trauma ( such as a Zoledronate treatment significantly restored hindlimb fracture , a surgery, a crushing injury, a cutting injuryy , a 60 weiweight bearing as compared to vehicle treatment ( over 90 % scratch , or a puncture injury ) , natural history, signs, symp - of normal) . toms, and pathologic changes observed in human CRPS As can be seen in FIG . 16 , orally administering zoledronic patients (Kingery W S et al. , Pain . 2003 ; 104: 75 -84 ) . acid four weeks after the fracture resulted in significantly Starting four weeks after fracture and casting , animals greater improvement of pain relief as compared to admin were orally administered either vehicle ( control) or zole istration at the time of injury . US 10 ,016 ,446 B2 65 66 restenEXAMPLE 10 US 10016.A . B

HCl, water OH 99 . 7 % 7 87. 7 % HO ??????? ???10 PO3H2 1 H3PO3, PC13, H20 C1 PO3H2 i. H3PO3, 10 eq. , OH toluene, 70° C ., 20 min Compound 1 ii . PC13 , 95° C . , 2 h la ). Formulaireiii. HCI, H20 , 100° C . , 7 h , rt , 2 d PO3H A PO32PO32 - ]] PO3H2 PO3H2 11 4 Na NaOH c1 "HO3P POZH H20 | H2O3P PO3H2 HO OH HO OH Na saltOUR of Compound 2 L= CompoundEI 2 1 , 3 -Bis ( 2 -methoxy - 2 -oxoethyl )- 1H - imidazol- 3 - ium chlo The following embodiments are specifically contem ride ( 9 ). Methyl chloroacetate ( 29 .8 mL , 338 .6 mmol , 2 .0 plated : eq ) was added drop - wise to 1 - ( trimethylsilyl) - 1H - imidazole Embodiment 1 . A method of relieving inflammatory pain ( 8 ; 25 . 0 mL, 169. 3 mmol ) . The mixture was heated at 60° C . 30 comprising administering an oral dosage form contain for 24 hours . The mixture was cooled to room temperature , ing zoledronic acid to a mammal in need thereof, washed with Et, o (3x500 mL ) and dried in vacuo yielding wherein the mammal receives a total monthly dose of 9 (41 . 97 g , 168 . 8 mmol, 99 . 7 % ) as a white solid . zoledronic acid that is about 800 mg/m² or less based 1, 3 -Bis ( carboxymethyl) - 1H - imidazol- 3 -ium chloride upon the body surface area of the mammal . ( 10 ) To 1 , 3 -bis ( 2 -methoxy - 2 -oxoethyl ) - 1H - imidazol- 3 - ium 35 Embodiment 2 . The method of embodiment 1 , wherein chloride ( 9 ; 41. 00 g , 164 .88 mmol, 1 eq .) was added 37 % aq . the mammal is a human being that receives a total HCI ( 30 . 03 mL , 362. 74 mmol, 2 . 2 eq. ) . The mixture was monthly dose of zoledronic acid that is about 30 mg/ m² stirred under reflux for 0 . 5 hour. The mixture was concen to about 700 mg/ m² . trated and the remaining solid was washed with acetone Embodiment 3 . The method of embodiment 2 , wherein (2x200 mL ) and Et, O (3x200 mL ) . Drying in vacuo gave 10 40 the total monthly dose is administered in 4 or 5 weekly (31 . 89 g , 144 . 55 mmol, 87. 7 % ) as a white solid . doses . Compound 1 : Compound 10 is reacted with an equimolar Embodiment 4 . The method of embodiment 2 , wherein amount of phosphorous acid , followed by an equimolar the totalmonthly dose is administered in 28 to 31 daily amount of phosphorous trichloride , and an excess of water doses . to form Compound 1, which is precipitated from ethanol. 45 Embodiment 5 . The method of embodiment 2 , wherein Compound 2 : 1 , 3 - Bis ( carboxymethyl) - 1H - imidazol- 3 the total monthly dose is administered in 5 to 10 ium chloride ( 10 , 2. 00 g , 9 mmol, 1 .0 eq ) and H3PO3 ( 7 .37 individual doses during the month . g , 90 mmol, 10 eq ) were dissolved in toluene ( 10 mL ) and Embodiment 6 . The method of embodiment 1 , wherein heated to 70° C . The reaction mixture was stirred at this the mammal is a human being that receives a total temperature for 20 min before PC1z ( 16 mL , 180 mmol, 20 50 weekly dose of zoledronic acid that is about 10 mg to eq ) was added within 30 min . The reaction mixture was then about 300 mg. heated to 95° C . and stirred at this temperature for 2 h . Then , Embodiment 7 . The method of embodiment 6 , wherein aq . HC1 ( 30 mL , 37 % HCl and 5 mL H20 ) was added . The the total weekly dose is a single dose , administered reaction mixture was heated to 100° C . and stirred at this once a week . temperature for 7 h , then stirred at room temperature for 2 55 Embodiment 8 . The method of embodiment 6 , wherein days and filtered . The filtrate was cooled in an ice bath and the total weekly dose is administered in 2 to 7 indi added within 45 min to absolute EtOH (90 mL ) . The vidual doses during the week . resulting turbid solution was stirred for 1 h at room tem Embodiment 9 . The method of embodiment 1 , wherein perature before the solid was filtered off . The filter cake the mammal is a human being that receives a total (Compound 2 ) was isolated and analyzed by 2D -NMR 60 weekly dose of zoledronic acid that is about 10 mg to spectroscopy and mass spectrometry ( m /z = 477) . The filtrate about 150 mg was concentrated in vacuo to give a residue. This residue Embodiment 10 . The method of any preceding embodi (500 mg) was treated with aq. NaOH ( 150 mg in 3. 5 mL of ment, wherein the mammal experiences significant pain H , O ) and EtOH ( 7 mL ) . After standing overnight the liquid relief more than 3 hours after administration of the was decanted and the resulting solid (Na salt of Compound 65 dosage form . 2 ) was obtained and analyzed by NMR and mass spectrom Embodiment 11 . The method of embodiment 10 , wherein etry (m /z = 477 ) . the mammal experiences significant pain relief during US 10 , 016 , 446 B2 68 at least a part of a time from about 3 hours to about 24 Embodiment 30 . The method of embodiment 29 , wherein hours after administration of the dosage form . the human being experiences significant pain relief Embodiment 12 . The method of embodiment 10 , wherein during at least a part of a time from about 3 hours to the mammal experiences significant pain relief during about 24 hours after administration of the dosage form . at least a part of a time from about 3 hours to about 3 5 Embodiment 31. The method of embodiment 29 , wherein weeks after administration of the dosage form . the human being experiences significant pain relief Embodiment 13 . A method of relieving inflammatory pain during at least a part of a time from about 3 hours to comprising administering an oral dosage form contain about 3 weeks after administration of the dosage form . ing zoledronic acid to a mammal in need thereof, Embodiment 32 . The method of any of embodiments wherein the oral dosage form contains about 10 mg/m² 10 20 - 31 , wherein the dosage form contains about 10 to about 20 mg/ m² of zoledronic acid based upon the mg/ m2 to about 20 mg/m² of zoledronic acid based body surface area of the mammal. upon the body surface area of the human being . Embodiment 14 . The method of embodiment 13 , wherein Embodiment 33 . The method of embodiment 32 , wherein the oral dosage form contains about 15 mg/m² to about 15 the dosage form contains about 15 mg/ m² to about 20 20 mg/ m² of zoledronic acid based upon the body mg/ m - of zoledronic acid based upon the body surface surface area of the mammal. area of the human being . Embodiment 15 . A method of relieving inflammatory pain Embodiment 34 . The method of any of embodiments comprising orally administering to a mammal in need 20 -33 , wherein about 50 mg/ m² to about 200 mg/ m² of thereof, about 300 mg/ m² to about 600 mg/ m² of 20 zoledronic acid is orally administered per month , based zoledronic acid per month to the mammal, based upon upon the body surface area of the human being . the body surface area of the mammal. Embodiment 35 . The method of any of embodiments Embodiment 16 . The method of embodiment 15 , com 20 -31 , wherein the dosage form contains about 80 prising orally administering about 450 mg/ m² to about mg/ m² to about 150 mg/ m² of zoledronic acid based 600 mg/ m ' of zoledronic acid per month to the mam - 25 upon the body surface area of the human being . mal, based upon the body surface area of the mammal. Embodiment 36 . Themethod of embodiment 35 , wherein Embodiment 17 . The method of any preceding embodi about 300 mg/m2 to about 1000 mg/ m² of zoledronic ment, wherein the mammal is not suffering from bone acid is orally administered per month , based upon the metastasis . body surface area of the human being . Embodiment 18 . The method of any preceding embodi- 30 Embodiment 37 . The method of any of embodiments ment , wherein the mammal is not suffering from can 20 -36 , wherein the human being is not suffering from cer . bone metastasis. Embodiment 19 . The method of any preceding embodi Embodiment 38 . The method of any of embodiments ment, wherein the zoledronic acid is administered as a 20 -37 , wherein the human being is not suffering from salt of a dianion of zoledronic acid . cancer. Embodiment 20 . A method of relieving pain associated Embodiment 39 . The method of any preceding embodi with an arthritis comprising administering an oral dos ment , wherein the zoledronic acid is in the disodium age form containing zoledronic acid to a human being salt form . in need thereof. Embodiment 40 . An oral dosage form comprising zole Embodiment 21. The method of embodiment 20 , wherein 40 dronic acid , wherein the oral bioavailability of zole the human being receives a total monthly dose of dronic acid in the dosage form is about 0 . 01 % to about zoledronic acid that is about 40 mg to about 2000 mg . 4 % . Embodiment 22 . The method of embodiment 21 , wherein Embodiment 41. The oral dosage form of embodiment 40 , the total monthly dose is administered in 4 or 5 weekly wherein the oral dosage form contains about 10 mg to doses . 45 about 300 mg of zoledronic acid . Embodiment 23 . The method of embodiment 21, wherein Embodiment 42 . The oral dosage form of embodiment 40 , the total monthly dose is administered in 28 to 31 daily wherein the oral dosage form contains about 10 mg to doses . about 50 mg of zoledronic acid . Embodiment 24 . The method of embodiment 21 , wherein Embodiment 43 . The oral dosage form of any of embodi the total monthly dose is administered in 5 to 10 50 ments 40 - 42 , wherein the oral bioavailability of zole individual doses during the month . dronic acid in the dosage form is about 0 . 1 % to about Embodiment 25 . The method of embodiment 20 , wherein 2 % . the human being receives a total weekly dose of Embodiment 44 . A pharmaceutical product comprising zoledronic acid that is about 100 mg to about 300 mg . more than one unit of an oral dosage form of embodi Embodiment 26 . Themethod of embodiment 25 , wherein 55 ment 40 . the total weekly dose is a single dose , administered Embodiment 45 . The pharmaceutical product of embodi once a week . ment 44, wherein each unit of the oral dosage form Embodiment 27 . The method of embodiment 25 , wherein contains about 1 mg to about 50 mg of zoledronic acid . the total weekly dose is administered in 2 to 7 indi Embodiment 46 . The pharmaceutical product of embodi vidual doses during the week . ment 45 , comprising 28 , 29 , 30 , or 31 units of the oral Embodiment 28 . The method of embodiment 20 , wherein dosage form , for a total of about 28 mg to about 1600 the human being receives a total weekly dose of mg of zoledronic acid to be administered in about 1 zoledronic acid that is about 10 mg to about 100 mg. month . Embodiment 29. The method of any of embodiments Embodiment 47 . The pharmaceutical product of embodi 20 - 28 , wherein the human being experiences signifi - 65 ment 45 , comprising 85 to 95 units of the oral dosage cant pain relief more than 3 hours after administration form , for a total of about 85 mg to about 4800 mg of of the dosage form . zoledronic acid to be administered in about 3 months . US 10 , 016 , 446 B2 69 70 Embodiment 48 . The pharmaceutical product of embodi Embodiment 65. Themethod of embodiment63 , wherein ment 45 , comprising 170 to 200 units of the oral dosage 28 to 31 daily doses are administered in a period of one form , for a total of about 170 mg to about 10 , 000 mg month or less . of zoledronic acid to be administered in about 6 Embodiment 66 . The method of embodiment 63 , wherein months. 5 5 to 10 individual doses are administered during a Embodiment 49 . The pharmaceutical product of embodi period of one month or less . ment 45 , comprising 350 to 380 units of the oral dosage Embodiment 67 . The method of embodiment 63 , wherein form , for a total of about 350 mg to about 19 ,000 mg of zoledronic acid to be administered in about 1 year. about 30 mg/ m² to about 700 mg/ m ? of zoledronic acid Embodiment 50 . The pharmaceutical product of embodi- 10 is administered during only one month . ment 44 , wherein each unit of the oral dosage form Embodiment 68 . The method of embodiment 63 , wherein contains about 10 mg to about 300 mg. about 30 mg /m² to about 700 mg/ m² of zoledronic acid Embodiment 51. The pharmaceutical product of embodi is administered in a period of one month or less for 2 ment 50 , comprising 4 or 5 units of the oral dosage or more consecutive months . form , for a total of about 40 mg to about 1500 mg of 15 Embodiment 69. The method of embodiment 62 , wherein zoledronic acid to be administered within a period of the mammal receives about 10 mg/ m² to about 30 about 1 month . mg/ m² of zoledronic acid daily . Embodiment 52 . The pharmaceutical product of embodi Embodiment 70 . The method of embodiment 62 , wherein ment 50 , comprising 8 or 9 units of the oral dosage the mammal is a human being that receives a total form , for a total of about 80 mg to about 2700 mg of 20 weekly dose of zoledronic acid that is about 10 mg to zoledronic acid to be administered in about 2 months . about 300 mg. Embodiment 53 . The pharmaceutical product of embodi Embodiment 71 . The method of embodiment 70 , wherein ment 50 , comprising 12 , 13 or 14 units of the oral the total weekly dose is a single dose , administered dosage form , for a total of about 120 mg to about 4200 once a week . mg of zoledronic acid to be administered in about 3 25 Embodiment 72 . The method of embodiment 70 , wherein months . the total weekly dose is administered in 2 to 7 indi Embodiment 54 . The pharmaceutical product of embodi vidual doses during the week . ment 50 , comprising 22 to 30 units of the oral dosage Embodiment 73 . The method of any of embodiments form , for a total of about 220 mg to about 9000 mg of 62 -72 , wherein the complex regional pain syndrome is zoledronic acid to be administered in about 6 months . 30 complex regional pain syndrome type I . Embodiment 55 . The pharmaceutical product of embodi Embodiment 74 . The method of any of embodiments ment 50 , comprising 45 to 60 units of the oral dosage 62 -72 , wherein the complex regional pain syndrome is form , for a total of about 450 mg to about 18000 mg of complex regional pain syndrome type II . zoledronic acid to be administered in about 1 year. Embodiment 75 . The method of any preceding embodi Embodiment 56 . The pharmaceutical product of embodi- 35 ment, wherein the zoledronic acid is in a salt form . ment 44 , comprising 1 to 10 units of the oral dosage Embodiment 76 . The method of any of embodiments form , wherein the product contains about 200 mg to 62 - 75 , wherein the dosage form contains about 10 about 2000 mg of zoledronic acid . mg/ m2 to about 20 mg/ m ? of zoledronic acid based Embodiment 57. The oral dosage form of any preceding upon the body surface area of the mammal. embodiment, wherein the zoledronic acid is in the form 40 Embodiment 77 . The method of embodiment 76 , wherein of a sodium salt . the dosage form contains about 15 mg/ m² to about 20 Embodiment 58. The oral dosage form of any preceding mg/m² of zoledronic acid based upon the body surface embodiment, wherein the zoledronic acid is in a form area of the mammal. that has an aqueous solubility greater than 1 % ( w / v ) . Embodiment 78 . A method of treating complex regional Embodiment 59 . The oral dosage form of any preceding 45 pain syndrome, comprising administering pamidronic embodiment , wherein the zoledronic acid is in a form acid to a human being in need thereof. that has an aqueous solubility of about 5 % ( w / v ) to Embodiment 79 . A method of treating complex regional about 50 % ( w /v ). pain syndrome, comprising administering neridronic Embodiment 60 . An oral dosage form comprising zole acid to a human being in need thereof . dronic acid and an excipient, wherein the zoledronic 50 Embodiment 80 . A method of treating complex regional acid is in a form that has an aqueous solubility greater pain syndrome, comprising administering olpadronic than 1 % ( w / v ) . acid to a human being in need thereof . Embodiment 61. The oral dosage form of embodiment60 , Embodiment 81 . A method of treating complex regional wherein the zoledronic acid is in a form that has an pain syndrome, comprising administering alendronic aqueous solubility of about 5 % ( w / v ) to about 50 % 55 acid to a human being in need thereof. ( w / v ) . Embodiment 82 . A method of treating complex regional Embodiment 62. A method of treating complex regional pain syndrome, comprising administering incadronic pain syndrome comprising administering an oral dos acid to a human being in need thereof. age form containing zoledronic acid to a mammal in Embodiment 83 . A method of treating complex regional need thereof. pain syndrome, comprising administering ibandronic Embodiment 63 . The method of embodiment 62 , wherein acid to a human being in need thereof. the mammal is a human being that receives an amount Embodiment 84 . A method of treating complex regional of zoledronic acid that is about 30 mg/ m² to about 700 pain syndrome, comprising administering risedronic mg/m² in a period of one month or less. acid to a human being in need thereof. Embodiment 64 . The method of embodiment63 , wherein 65 Embodiment 85 . A method of treating pain , comprising 4 or 5 weekly doses are administered in a period of one administering pamidronic acid to a human being in month or less . need thereof. US 10 ,016 ,446 B2 71 72 Embodiment 86 . A method of treating pain , comprising Embodiment 108. A method of treating arthritis pain , administering neridronic acid to a human being in need comprising administering etidronic acid to a human thereof. being in need thereof. Embodiment 87 . A method of treating pain , comprisingng Embodiment 109. A method of treating inflammatory administering olpadronic acid to a human being in need 5 pain , comprising administering etidronic acid to a human being in need thereof. thereof . Embodiment 110 . A method of treating complex regional Embodiment 88 . A method of treating pain , comprising pain syndrome, comprising administering clodronic administering alendronic acid to a human being in need acid to a human being in need thereof. thereof. Embodiment 111 . A method of treating pain , comprising Embodiment 89 . A method of treating pain , comprising administering clodronic acid to a human being in need administering incadronic acid to a human being in need thereof. thereof . Embodiment 112. A method of treating arthritis pain , Embodiment 90 . A method of treating pain , comprising comprising administering clodronic acid to a human administering ibandronic acid to a human being in need 15 being in need thereof. thereof. Embodiment 113 . A method of treating inflammatory Embodiment 91. A method of treating pain , comprising pain , comprising administering clodronic acid to a administering risedronic acid to a human being in need human being in need thereof. thereof. Embodiment 114 . A method of treating complex regional Embodiment 92. A method of treating arthritis pain , 20 pain syndrome, comprising administering tiludronic comprising administering pamidronic acid to a human acid to a human being in need thereof. being in need thereof. Embodiment 115 . A method of treating pain , comprising Embodiment 93. A method of treating arthritis pain , administering tiludronic acid to a human being in need comprising administering neridronic acid to a human thereof. being in need thereof. 25 . Embodiment 116 . A method of treating arthritis pain , Embodiment 94 . A method of treating arthritis pain , comprising administering tiludronic acid to a human comprising administering olpadronic acid to a human being in need thereof. being in need thereof. Embodiment 117 . A method of treating inflammatory Embodiment 95 . A method of treating arthritis pain , pain , comprising administering tiludronic acid to a comprising administering alendronic acid to a human 30 human being in need thereof. being in need thereof. Embodiment 118 . The method of any of embodiments Embodiment 96 . A method of treating arthritis pain , 78 - 117 , wherein the active compound is orally admin comprising administering incadronic acid to a human istered . being in need thereof. Embodiment 119 . The method of any of embodiments Embodiment 97 . A method of treating arthritis pain , 35 78 - 117 , wherein the active compound is parenterally comprising administering ibandronic acid to a human administered . being in need thereof. Embodiment 120 . A method of enhancing the oral bio Embodiment 98 . A method of treating arthritis pain , availability of zoledronic acid comprising orally comprising administering risedronic acid to a human administering a dosage form containing zoledronic acid being in need thereof. 40 in the disodium salt form . Embodiment 99 . A method of treating inflammatory pain , Embodiment 121 . The method of embodiment 120 , comprising administering pamidronic acid to a human wherein the zoledronic acid in the disodium salt form being in need thereof . provides an enhancement to bioavailability , as com Embodiment 100 . A method of treating inflammatory pared to zoledronic acid in the diacid form , which adds pain , comprising administering neridronic acid to a 45 to any enhancement to bioavailability provided by any human being in need thereof. bioavailability - enhancing agents in the dosage form . Embodiment 101. A method of treating inflammatory Embodiment 122 . The method of embodiment 120 , pain , comprising administering olpadronic acid to a wherein the dosage form is substantially free of bio human being in need thereof. availability - enhancing agents . Embodiment 102 . A method of treating inflammatory 50 Embodiment 123 . The method of embodiment 120 , pain , comprising administering alendronic acid to a wherein the zoledronic acid in the disodium salt form human being in need thereof. is administered to a mammal in an amount that pro Embodiment 103. A method of treating inflammatory vides an area under the plasma concentration curve of pain , comprising administering incadronic acid to a zoledronic acid of about 4 ng. h /mL to about 2000 human being in need thereof . 55 ng. h /mL to the mammal each time the zoledronic acid Embodiment 104 . A method of treating inflammatory in the disodium salt is administered . pain , comprising administering ibandronic acid to a Embodiment 124 . The method of embodiment 123 , human being in need thereof. wherein the zoledronic acid in the disodium salt form Embodiment 105 . A method of treating inflammatory is administered at an interval of about 3 to about 4 pain , comprising administering risedronic acid to a 60 weeks in an amount that provides an area under the human being in need thereof. plasma concentration curve of zoledronic acid of about Embodiment 106 . A method of treating complex regional 100 ng- h /mL to about 2000 ng h /mL to the mammal pain syndrome, comprising administering etidronic each time the zoledronic acid in the disodium salt form acid to a human being in need thereof. is administered . Embodiment 107 . A method of treating pain , comprising 65 Embodiment 125 . The method of embodiment 123 , administering etidronic acid to a human being in need wherein the zoledronic acid in the disodium salt form thereof. is administered weekly , or 3 to 5 times in a month , in US 10 ,016 , 446 B2 73 74 an amount that provides an area under the plasma salt form is greater than the bioavailability of zole concentration curve of zoledronic acid of about 20 dronic acid in the diacid form would be in the same ng - h /mL to about 700 ng- h /mL to the mammal each dosage form . time the zoledronic acid in the disodium salt form is Embodiment 138 . A dosage form comprising zoledronic administered . 55 acid in the disodium salt form , wherein the dosage form Embodiment 126 . The method of embodiment 123 , contains an amount of zoledronic acid in the disodium wherein the zoledronic acid in the disodium salt form salt form that provides an area under the plasma is administered daily in an amount that provides an area concentration curve of zoledronic acid of about 4 under the plasma concentration curve of zoledronic ng - h /mL to about 2000 ng -h /mL to a human being to acid of about 4 ng. h /mL to about 100 ng h /mL to the which the dosage form is administered . mammal each time the zoledronic acid in the disodium Embodiment 139. The dosage form of embodiment 138 , salt form is administered . wherein the dosage form contains an amount of zole Embodiment 127 . The method of embodiment 120 , dronic acid in the disodium salt form that provides an wherein the dosage form is a solid . area under the plasma concentration curve of zole Embodiment 128 . The method of embodiment 120 , 121 , 15 dronic acid of about 100 ng h /mL to about 2000 ng - h / 122 , 123 , 124 , 125 , 126 , or 127, wherein the bioavail mL to a human being to which the dosage form is ability of zoledronic acid is improved by at least about administered . 20 % as compared to administration of zoledronic acid Embodiment 140 . The dosage form of embodiment 138 , in the diacid form . 20 wherein the dosage form contains an amount of zole Embodiment 129 . The method of embodiment 120 , 121 , dronic acid in the disodium salt form that provides an 122 , 123 , 124 , 125, 126 , 127 , or 128 , further compris area under the plasma concentration curve of zole ing administering , on a molar basis , less of the zole dronic acid of about 20 ng .h /mL to about 700 ng. h /mL dronic acid in the disodium salt form than would be to a human being to which the dosage form is admin administered of zoledronic acid in the diacid form in 25 istered order to achieve the same plasma levels of zoledronic Embodiment 141 . The dosage form of embodiment 138 , acid . wherein the dosage form contains an amount of zole Embodiment 130 . The method of embodiment 129 , dronic acid in the disodium salt form that provides an wherein at least about 10 mole % less of the disodium area under the plasma concentration curve of zole salt form is administered as compared the amount of 30 dronic acid of about 4 ng- h /mL to about 100 ng. h /mL zoledronic acid in the diacid form that would be to a human being to which the dosage form is admin administered in order to achieve the same plasma levels istered . of zoledronic acid . Embodiment 142 . A dosage form comprising zoledronic Embodiment 131 . The method of embodiment 129 , acid in the disodium salt form , wherein the disodium salt form is administered in an· 35 wherein the disodium salt form is present in a lower molar amount, on a molar basis , that has a value of about amount than would be present if the zoledronic acid 0 .8n , to about 1. 2n2, wherein : were in the diacid form ; and wherein the zoledronic acid in the disodium salt form has an improved bioavailability as compared to the zole ng ( bdba ) (na ) 40 wherein b , is the bioavailability of the diacid form ,by is the dronic acid in the diacid form to the extent that the bioavailability of the disodium salt form , and n , is the lower molar amount of the disodium salt in the dosage number of moles of zoledronic acid in the diacid form that form does not reduce the amount of zoledronic acid would be administered in order to achieve the same plasma delivered to the plasma of a mammal . levels of zoledronic acid . 45 Embodiment 143 . The dosage form of embodiment 137 , Embodiment 132 . The method of embodiment 131 , 138 , 139, 140 , 141, or 142, wherein the dosage form is wherein the disodium salt is administered in an amount a solid . that has a value of about ng. Embodiment 144 . The dosage form of embodiment 142 or Embodiment 133 . The method of any of embodiments 143 , wherein the bioavailability of zoledronic acid in 120 - 132 , wherein the zoledronic acid is used to treat an 50 the disodium salt form is improved by at least about inflammatory condition . 10 % as compared to an otherwise identical dosage form Embodiment 134 . The method of embodiment 133 , containing zoledronic acid in the diacid form . wherein the zoledronic acid is used to treat arthritis . Embodiment 145 . The dosage form of embodiment 142 , Embodiment 135 . The method of embodiment 133 , 143 , or 144 , containing at least about 20 mole % less of wherein the zoledronic acid is used to treat complex 55 the disodium salt form as compared to the amount of regional pain syndrome. the zoledronic acid in the diacid form that would be Embodiment 136 . The method of any of embodiments present if the zoledronic acid were in the diacid form . 1 -39 , 62- 77 , and 120 - 135 , wherein : Embodiment 146 . The dosage form of embodiment 142, a first oral dosage form is administered ; and wherein the disodium salt form is present in an amount , a second oral dosage form is administered ; 60 on a molar basis , that has a value of about 0 . 9n , to wherein , with respect to the first oral dosage form , the about 1 . 1nj, wherein : second oral dosage form is administered at 10xTmar or greater , wherein Tmax is the time of maximum plasma nF (bdba ) ( na ) concentration for the first oral dosage form . wherein ba is the bioavailability of the diacid form , bais Embodiment 137. A dosage form comprising zoledronic 65 the bioavailability of the disodium salt form , and ng is acid in the disodium salt form , wherein the bioavail the number ofmoles of the diacid form that would be ability , in a mammal, of zoledronic acid in the disodium present if the zoledronic acid were in the diacid form . US 10 , 016 , 446 B2 75 76 Embodiment 147 . The dosage form of embodiment 146 , food or drink beverage for at least 30 minutes after the wherein the disodium salt is administered in an amount zoledronic acid is administered . that has a value of about ng. Embodiment 162 . The method of embodiment 161, Embodiment 148 . The method of any of embodiments wherein the mammal or human being to which the 1 -39 , 62 -77 , and 120 - 136 , wherein : 5 zoledronic acid is administered does not eat food or only a single oral dosage form is administered ; or drink beverage for at least 1 hour after the zoledronic a first oral dosage form is administered , and a second oral acid is administered . dosage form is administered after the first oral dosage Embodiment 163 . The method of embodiment 161, where form , wherein the second oral dosage form is admin in the mammal or human being to which the zoledronic istered before the maximum pain relieving effect of the 10 acid is administered does not eat food or drink beverage for at least 2 hours after the zoledronic acid is admin first oral dosage form is achieved , or the second oral istered . dosage form is administered before an observable pain Embodiment 164. The method , dosage form , or product , relieving effect is achieved . of any preceding embodiment, wherein the zoledronic Embodiment 149 . The method of embodiment 148 , acid in the oral dosage form has a 24 hour sustained wherein the second oral dosage form is administered plasma level factor of about 1 or higher. before an observable pain relieving effect is achieved . Embodiment 165 . The method , dosage form , or product , Embodiment 150 . The method of any of embodiments of any preceding embodiment, wherein the zoledronic 1 - 39 , 62 - 77 , and 120 - 132, wherein a first dosage form acid in the oral dosage form has a 24 hour sustained is administered , followed by administration of a second 20 plasma level factor that is higher than that of intrave dosage form , wherein the second dosage form is nously administered zoledronic acid . administered after the maximum pain relieving effect of Embodiment 166 . The method , dosage form , or product, the first oral dosage form is achieved , and the second of any preceding embodiment, wherein the oral dosage oral dosage form is administered while a pain relieving form is a solid that has a hardness of about 5 kPa to effect from the first oral dosage form is observable . 25 about 20 kPa . Embodiment 151 . The method of embodiment 148 , 149 , Embodiment 167 . A method of treating bone marrow or 150 , wherein the second oral dosage form is admin lesions comprising: selecting a patient having a bone istered about 24 hours to about 28 days after the first marrow lesion and OARSI grade 0 of joint space oral dosage form is administered . narrowing, and administering an inhibitor of osteoclast Embodiment 152 . The method of any of embodiments 30 activity to the patient for the treatment of the bone 20 -39 , wherein the human being is about 30 years old marrow lesion . to about 75 years old . Embodiment 168 . The method of embodiment 167 , Embodiment 153 . The method of any of embodiments wherein the inhibitor of osteoclast activity is adminis 20 - 39 , wherein the human being is about 1 year old to tered at least twice . about 16 years old . 35 Embodiment 169 . The method of embodiment 167 , Embodiment 154 . The method of any of embodiments wherein the inhibitor of osteoclast activity is adminis 20 - 39, wherein the human being is about 80 years old tered about every three months , or more frequently . to about 95 years old . Embodiment 170 . The method of embodiment 167 , Embodiment 155 . The method of any of embodiments wherein the inhibitor of osteoclast activity comprises a 20 - 39 , wherein the human being has suffered from the 40 nitrogen - containing bisphosphonate . arthritis for at least 2 months . Embodiment 171 . The method of any one of embodiments Embodiment 156 . The method of any of embodiments 167 - 170 , wherein the inhibitor of osteoclast activity is 20 - 39, wherein the arthritis affects , a knee, an elbow , a or comprises zoledronic acid . wrist, a shoulder , or a hip . Embodiment 172 . The method of any one of embodiments Embodiment 157 . The method of any of embodiments 45 167 - 170 , wherein the inhibitor of osteoclast activity is 1 - 44 , 62- 133 , and 144 - 156 , wherein the mammal or or comprises pamidronic acid . human being to which the zoledronic acid is adminis Embodiment 173 . The method of any one of embodiments tered does not eat food or drink beverage for at least 1 167 - 170 , wherein the inhibitor of osteoclast activity is hour before the zoledronic acid is administered . or comprises neridronic acid . Embodiment 158 . The method of embodiment 157, 50 Embodiment 174 . The method of any one of embodiments wherein the mammal or human being to which the 167 - 170 , wherein the inhibitor of osteoclast activity is zoledronic acid is administered does not eat food or or comprises olpadronic acid . drink beverage for at least 2 hours before the zoledronic Embodiment 175 . Themethod of any one of embodiments acid is administered . 167 - 170 , wherein the inhibitor of osteoclast activity is Embodiment 159 . The method of embodiment 158 , 55 or comprises alendronic acid . wherein the mammal or human being to which the Embodiment 176 . The method of any one of embodiments zoledronic acid is administered does not eat food or 167 - 170 , wherein the inhibitor of osteoclast activity is drink beverage for at least 4 hours before the zoledronic or comprises incadronic acid . acid is administered . Embodiment 177 . The method of any one of embodiments Embodiment 160 . The method of embodiment 159 , 60 167- 170 , wherein the inhibitor of osteoclast activity is wherein the mammal or human being to which the or comprises ibandronic acid . zoledronic acid is administered does not eat food or Embodiment 178 . The method of any one of embodiments drink beverage for at least 6 hours before the zoledronic 167 - 170 , wherein the inhibitor of osteoclast activity is acid is administered . or comprises risedronic acid . Embodiment 161 . The method of any of embodiments 65 Embodiment 179. The method of any one of embodiments 157 - 160 , wherein the mammal or human being to 167 - 178 , wherein the inhibitor of osteoclast activity is which the zoledronic acid is administered does not eat administered orally . US 10 , 016 , 446 B2 77 78 Embodiment 180 . The method of any one of embodiments Embodiment 199. The method of any one of embodiments 167 - 178 , wherein the inhibitor of osteoclast activity is 186 - 198 , wherein the patient experiences a reduction in administered intravenously. pain intensity — when using a 100 mm visual analog Embodiment 181. The method of any one of embodiments scale of at least about 20 . 167 - 180 , wherein the patient experiences a reduction in 5 Embodiment 200 . A method of treating a bone marrow bone marrow lesion size that is at least about 100 % lesion of the knee comprising : selecting a patient greater than a reduction in bone marrow lesion size achieved with a placebo . having a bone marrow lesion of the knee and OARSI Embodiment 182 . The method of any one of embodiments Grade 0 or Kellgren and Lawrence Grade 0 or Grade 1 167 - 180 , wherein the patient experiences a reduction in 10 of joint space narrowing , and administering an inhibitor bone marrow lesion size that is at least about 150 % of osteoclast activity to the patient for the treatment of greater than a reduction in bone marrow lesion size the bone marrow lesion . achieved with a placebo . Embodiment 201 . The method of embodiment 200 , Embodiment 183 . The method of any one of embodiments wherein the inhibitor of osteoclast activity is adminis 167 - 182 , wherein the inhibitor of osteoclast activity is 15 tered at least twice . administered at least twice over a period of at least four Embodiment 202 . The method of embodiment 201 , weeks . wherein the inhibitor of osteoclast activity is adminis Embodiment 184 . The method of any one of embodiments tered about every three months , or more frequently . 167 - 183 , wherein the inhibitor of osteoclast activity is Embodiment 203 . The method of embodiment 200 , administered once weekly for a period of six weeks . 20 wherein the inhibitor of osteoclast activity comprises a Embodiment 185 . The method of any one of embodiments nitrogen - containing bisphosphonate . 167- 184 , wherein the inhibitor of osteoclast activity Embodiment 204 . The method of embodiment 203 , comprises zoledronic acid , and the weekly dose is wherein the inhibitor of osteoclast activity is zoledronic between about 25 mg and about 75 mg . acid . Embodiment 186 . A method of treating knee pain com - 25 Embodiment 205 . The method of embodiment 203 , prising : selecting a patient having knee pain and wherein the inhibitor of osteoclast activity is OARSI grade 0 of joint space narrowing , and admin pamidronic acid . istering an inhibitor of osteoclast activity to the patient Embodiment 206 . The method of embodiment 203 , for the treatment of the knee pain . wherein the inhibitor of osteoclast activity is neridronic Embodiment 187 . The method of embodiment 186 , 30 acid . wherein the inhibitor of osteoclast activity is adminis Embodiment 207. The method of embodiment 203 , tered at least twice . wherein the inhibitor ofosteoclast activity is olpadronic Embodiment 188 . Themethod of any one of embodiments acid . 186 - 187 , wherein the inhibitor of osteoclast activity is Embodiment 208 . The method of embodiment 203 , administered about every three months, or more fre - 35 wherein the inhibitor of osteoclast activity is mino quently . dronic acid . Embodiment 189 . The method of any one of embodiments Embodiment 209 . The method of embodiment 203 , 186 - 188 , wherein the inhibitor of osteoclast activity wherein the inhibitor of osteoclast activity is incadronic comprises a nitrogen - containing bisphosphonate . acid . Embodiment 190 . The method of any one of embodiments 40 Embodiment 210 . The method of embodiment 203 , 186 - 189 , wherein the patient experiences pain relief wherein the inhibitor of osteoclast activity is ibandronic three months after administration of the inhibitor of acid . osteoclast activity . Embodiment 211 . The method of embodiment 203 , Embodiment 191. The method of any one of embodiments wherein the inhibitor of osteoclast activity is risedronic 186 - 190 , wherein the inhibitor of osteoclast activity is 45 acid . or comprises zoledronic acid . Embodiment 212 . The method of embodiment 203 , Embodiment 192. The method of any one of embodiments wherein the inhibitor of osteoclast activity is alendronic 186 - 190 , wherein the inhibitor of osteoclast activity is acid . or comprises pamidronic acid . Embodiment 213 . The method of embodiment 200 , Embodiment 193 . The method of any one of embodiments 50 wherein the inhibitor of osteoclast activity is adminis 186 - 190 , wherein the inhibitor of osteoclast activity is tered orally. or comprises neridronic acid . Embodiment 214 . The method of embodiment 200 , Embodiment 194 . The method of any one of embodiments wherein the inhibitor of osteoclast activity is adminis 186 - 190 , wherein the inhibitor of osteoclast activity is tered intravenously . or comprises olpadronic acid . 55 Embodiment 215 . The method of embodiment 200 , Embodiment 195 . The method of any one of embodiments wherein the patient experiences a reduction in bone 186 - 190 , wherein the inhibitor of osteoclast activity is marrow lesion size that is at least about 15 % within or comprises alendronic acid . about 6 months after the inhibitor of osteoclast activity Embodiment 196 . The method of any one of embodiments is administered to the patient. 186 - 190 , wherein the inhibitor of osteoclast activity is 60 Embodiment 216 . The method of embodiment 200 , or comprises incadronic acid . wherein the patient experiences a reduction in bone Embodiment 197 . The method of any one of embodiments marrow lesion size that is at least about 25 % within 186 - 190 , wherein the inhibitor of osteoclast activity is about 6 months after the inhibitor of osteoclast activity or comprises ibandronic acid . is administered to the patient. Embodiment 198 . The method of any one of embodiments 65 Embodiment 217 . The method of embodiment 201 , 186 - 190 , wherein the inhibitor of osteoclast activity is wherein the inhibitor of osteoclast activity is adminis or comprises risedronic acid . tered at least twice over a period of at least four weeks. US 10 , 016 , 446 B2 79 80 Embodiment 218 . The method of embodiment 201, Embodiment 236 . The method of embodiment 220 , wherein the inhibitor of osteoclast activity is adminis wherein the patient experiences a reduction in pain tered once weekly for a period of six weeks. intensity — when using a 100 mm visual analog scale Embodiment 219 . The method of embodiment 218 , of at least about 5 . wherein the inhibitor of osteoclast activity comprises 5 Embodiment 237 . The method of embodiment 220 , zoledronic acid , and the weekly dose is between about wherein the inhibitor of osteoclast activity is adminis 25 mg and about 75 mg. tered at least twice over a period of at least four weeks . Embodiment 220 . A method of treating knee pain com Embodiment 238 . The method of embodiment 220 , prising : wherein the inhibitor of osteoclast activity is adminis a . selecting a patient having knee pain , and : 10 tered once weekly for a period of six weeks . i. OARSI Grade ( or Kellgren and Lawrence Gradeen 0 Embodiment 239 . The method of embodiment 238 , or Grade 1 of joint space narrowing , or wherein the inhibitor of osteoclast activity comprises ii . pain intensity of 5 or greater measured using the 0 - 10 zoledronic acid , and the weekly dose is between about NRS or 5 cm or greater using the 10 cm VAS ; and 15 25 mg and about 75 mg. b . administering an inhibitor of osteoclast activity to the Embodiment 240 . A method of treating moderate to patient. severe knee pain comprising administering an inhibitor Embodiment 221. The method of embodiment 220 , com of osteoclast activity to a person suffering from mod prising selecting a patient having OARSI Grade 0 or erate to severe knee pain . Kellgren and Lawrence Grade ( or Grade 1 of joint 20 Embodiment 241. The method of embodiment 240 , space narrowing. wherein the person suffering from moderate to severe Embodiment 222 . Themethod of embodiment 220 or 221 , knee pain has a normal joint space in the knee . comprising selecting a patient having pain intensity of Embodiment 242 . The method of embodiment 240 , 5 or greater measured using the 0 - 10 NRS or 5 cm or wherein the inhibitor of osteoclast activity is adminis greater using the 10 cm VAS . 25 tered at least twice . Embodiment 223 . The method of embodiment 220 , Embodiment 243 . The method of embodiment 240 , wherein the inhibitor of osteoclast activity is adminis wherein the inhibitor of osteoclast activity is adminis tered about every three months , or more frequently . tered at least twice. Embodiment 244 . The method of embodiment 240 , Embodiment 224 . The method of embodiment 223 , wherein the inhibitor of osteoclast activity comprises a wherein the inhibitor of osteoclast activity is adminis - 30 nitrogen - containing bisphosphonate . tered about every three months , or more frequently . Embodiment 245 . The method of embodiment 240 , Embodiment 225 . The method of embodiment 220 , wherein the patient experiences pain relief within about wherein the inhibitor of osteoclast activity comprises a three months after the inhibitor of osteoclast activity is nitrogen - containing bisphosphonate . administered to the patient. Embodiment 226 . The method of embodiment 220 , Embodiment 246 . The method of embodiment 245 , wherein the patient experiences pain reliefwithin about wherein the patient experiences pain relief at least 24 three months after the inhibitor of osteoclast activity is hours after the inhibitor of osteoclast activity is admin administered to the patient. istered to the patient . Embodiment 227 . The method of embodiment 226 , 40 Embodiment 247 . The method of embodiment 240 , wherein the patient experiences pain relief at least 24 wherein the inhibitor of osteoclast activity is zoledronic hours after the inhibitor of osteoclast activity is admin acid . istered to the patient. Embodiment 248 . The method of embodiment 240 , Embodiment 228 . The method of embodiment 220 , wherein the inhibitor of osteoclast activity is mino wherein the inhibitor of osteoclast activity is zoledronic 45 dronic acid . acid . Embodiment 249 . The method of embodiment 240 , Embodiment 229 . The method of embodiment 220 , wherein the inhibitor of osteoclast activity is neridronic wherein the inhibitor of osteoclast activity is mino acid . dronic acid . Embodiment 250 . The method of embodiment 240 , Embodiment 230 . The method of embodiment 220 , 50 wherein the inhibitor of osteoclast activity is olpadronic wherein the inhibitor of osteoclast activity is neridronic acid . acid . Embodiment 251. The method of embodiment 240 , Embodiment 231. The method of embodiment 220 , wherein the inhibitor of osteoclast activity is alendronic wherein the inhibitor of osteoclast activity is olpadronic acid . acid . 55 Embodiment 252 . The method of embodiment 240 , Embodiment 232 . The method of embodiment 220 , wherein the inhibitor of osteoclast activity is incadronic wherein the inhibitor of osteoclast activity is alendronic acid . acid . Embodiment 253 . The method of embodiment 240 , Embodiment 233 . The method of embodiment 220 , wherein the inhibitor of osteoclast activity is ibandronic wherein the inhibitor of osteoclast activity is incadronic 60 acid . acid . Embodiment 254 . The method of embodiment 240 , Embodiment 234 . The method of embodiment 220 , wherein the inhibitor of osteoclast activity is risedronic wherein the inhibitor of osteoclast activity is ibandronic acid . acid . Embodiment 255 . The method of embodiment 240 , Embodiment 235 . The method of embodiment 220 , 65 wherein the patient experiences a reduction in pain wherein the inhibitor of osteoclast activity is risedronic intensity — when using a 100 mm visual analog scale acid . of at least about 5 . US 10 , 016 , 446 B2 82 Embodiment 256 . The method of embodiment 240 , Embodiment 269 . The method of any preceding embodi wherein the inhibitor of osteoclast activity is adminis ment, such as embodiment 268 , wherein the amount of tered at least twice over a period of at least four weeks . zoledronic acid that is combined with the excipient is Embodiment 257 . The method of embodiment 240 , such that the oral dosage form comprises more than wherein the inhibitor of osteoclast activity is adminis - 5 about 10 % zoledronic acid by weight. tered once weekly for a period of six weeks. Embodiment 270 . The method of any preceding embodi Embodiment 258 . The method of embodiment 257, ment, such as embodiment 268 or 269 , wherein the wherein the inhibitor of osteoclast activity comprises amount of zoledronic acid that is combined with the zoledronic acid , and the weekly dose is between about excipient is such that zoledronic acid is present in the 25 mg and about 75 mg. 10 Embodiment 259. A method of safely delivering zole oral dosage form in an amount that is 0 . 4 mg/ kg to dronic acid to the blood of a mammal through repeated about 3 mg/ kg based upon the weight of the mammal. oral administration comprising : Embodiment 271 . The method of any preceding embodi orally administering about 0 .4 mg/ kg to about 4 mg/ kg ment, such as embodiment 270 , wherein the amount of of zoledronic acid to the mammal no more frequently 15 zoledronic acid that is combined with the excipient is than once a day and more frequently than once a such that zoledronic acid is present in the oral dosage week ; or form in an amount that is 0 . 4 mg/ kg to about 1. 5 mg/kg orally amdinistering about 0 . 4 mg/ kg to about 10 based upon the weight of the mammal . mg/ kg to the mammal once a week , or less fre Embodiment 272 . The method of any preceding embodi quently . ment, such as embodiment 270 , wherein the amount of Embodiment 260 . The method of any preceding embodi zoledronic acid that is combined with the excipient is ment, such as embodiment 259 , wherein about 0 . 5 such that zoledronic acid is present in the oral dosage mg/ kg to about 2 mg/ kg is orally administered to the form in an amount that is 0 .6 mg/ kg to about 0 . 9 mg/ kg mammal daily . based upon the weight of the mammal. Embodiment 261 . The method of any preceding embodi- 25 Embodiment 273 . The method of any preceding embodi ment, such as embodiment 260 , wherein about 0 .6 ment, such as embodiment 268 , 269 , 270 , 271, or 272 , mg/ kg to about 0 . 9 mg/ kg is orally administered to the wherein the oral dosage form is safe for once daily mammal daily. administration of the oral dosage form for about 3 to Embodiment 262 . The method of any preceding embodi about 10 days . ment, such as embodiment 259 , wherein about 0 .5 30 mg/ kg to about 2 mg/ kg is orally administered to the Embodiment 274 . The method of any preceding embodi mammal weekly . ment , such as embodiment 268 , 269, 270 , 271, or 272 , Embodiment 263 . The method of any preceding embodi wherein the oral dosage form is safe for once weekly ment, such as embodiment 263 , wherein about 0 .6 administration of the oral dosage form for about 3 to mg/ kg to about 0 . 9 mg/kg is orally administered to the 35 about 10 weeks . mammal weekly . Embodiment 275 . A method of safely delivering zole Embodiment 264. The method of any preceding embodi dronic acid to the blood of a mammal through repeated ment, such as embodiment 259, 260 , 261, 262 , or 263 , oral administration comprising : wherein zoledronic acid is orally administered about 3 orally administering about 0 .05 mg/ kg to about 4 to about 10 times . 40 mg/ kg of zoledronic acid to the mammal no more Embodiment 265 . The method of any preceding embodi frequently than once a day and more frequently than ment, such as embodiment 259 , 260 , 261, 262 , 263 , or once a week ; or 264 , wherein zoledronic acid is orally administered in orally administering about 0 . 1 mg/ kg to about 10 a dosage form comprising more than about 10 % zole mg/ kg to the mammal once a week , or less frequently dronic acid by weight. 45 wherein zoledronic acid is orally administered at least 5 Embodiment 266 . The method of any preceding embodi times . ment, such as embodiment 259 , 260 , 261, 262 , 263 , Embodiment 276 . The method of any preceding embodi 264 , or 265, wherein zoledronic acid is administered in ment, such as embodiment 275 , wherein zoledronic a manner and amount that results in the mammal acid is orally administered about 5 to about 10 times. having an AUC0 - 24 of zoledronic acid that is about 50 50 Embodiment 277 . The method of any preceding embodi ng. h /mL to about 500 ng- h /mL with each administra ment, such as embodiment 275 or 276 , wherein zole tion of zoledronic acid . dronic acid is orally administered in a dosage form Embodiment 267 . The method of any preceding embodi comprising more than about 10 % zoledronic acid by ment, such as embodiment 266 , wherein zoledronic weight. acid is administered in a manner and amount that 55 Embodiment 278 . The method of any preceding embodi results in the mammal having an AUC0 -24 of zoledronic ment, such as embodiment 259 , 260 , 261 , 262 , 263 , acid that is about 100 ng h /mL to about 500 ng . h /mL 264 , 265 , 266 , 267 , 268 , 269 , 270 , 271 , 272 , 273 , 274 , with each administration of zoledronic acid . 275 , 276 , or 277 , wherein the mammal is a human Embodiment 268 . A method of preparing an oral dosage being . form that is safe for repeated administration to a 60 Embodiment 279 . The method of any preceding embodi mammal comprising combining zoledronic acid with ment, such as embodiment 259 , 260 , 261, 262 , 263, an excipient that is pharmaceutically acceptable to the 264 , 265 , 266 , 267 , 268 , 269 , 270 , 271, 272 , 273 , 274 , mammal, wherein the amount of zoledronic acid that is 275 , 276 , 277 , or 278 , wherein about 50 mg to about combined with the excipient is such that zoledronic 350 mg of oral zoledronic acid is administered to the acid is present in the oral dosage form in an amount that 65 mammal per month . is 0 . 4 mg/ kg to about 10 mg /kg based upon the weight Embodiment 280 . An oral dosage form prepared by the of the mammal . method of any preceding embodiment, such as embodi US 10 , 016 , 446 B2 83 84 ment 259 , 260 , 261, 262 , 263 , 264 , 265 , 266 , 267 , 268 , Embodiment 303 . The molecular complex of Embodi 269, 270 , 271, 272, 273 , 274 , 275 , 276 , 277, 278 , or ment 285 , wherein the amino acid ( including the DL 279 . mixture , a D - enantiomer, or an L - enantiomer ) is histi Embodiment 281. An oral dosage form prepared by the dine . method of any preceding embodiment, wherein an 5 Embodiment 304 . The molecular complex of Embodi osteoclast inhibitor, including a bisphosphonate , such ment 285 , wherein the amino acid ( including the DL as zoledronic acid , neridronic acid , etc . , is in a dosage mixture , a D - enantiomer, or an L - enantiomer ) is iso form containing one of, or a combination of, the leucine . ingredients in the Table E . Embodiment 305 . The molecular complex of Embodi Embodiment 282 . A molecular complex comprising zole - 10 ment 285 , wherein the amino acid ( including the DL dronic acid or neridronic acid in an acid or a salt form . mixture , a D - enantiomer, or an L - enantiomer ) is leu Embodiment 283 . The molecular complex of Embodi cine . ment 282 , further comprising a basic or a salt form of Embodiment 306 . The molecular complex of Embodi a ) an amine , b ) an amide , or c ) ammonium . ment 285 , wherein the amino acid ( including the DL Embodiment 284. The molecular complex of Embodi- 15 mixture , a D - enantiomer , or an L - enantiomer ) is ment 283 , wherein the molecular complex comprises methionine . ammonia in a salt form . Embodiment 307 . The molecular complex of Embodi Embodiment 285 . The molecular complex of Embodi ment 285 , wherein the amino acid ( including the DL ment 283 , wherein the amine is an amino acid . mixture , a D - enantiomer, or an L - enantiomer ) is phe Embodiment 286 . The molecular complex of Embodi- 20 nylalanine . ment 285 , wherein the amino acid is a lysine . Embodiment 308 . The molecular complex of Embodi Embodiment 287 . The molecular complex of Embodi ment 285 , wherein the amino acid ( including the DL ment 285 , wherein the amino acid is L - lysine . mixture , a D - enantiomer, or an L - enantiomer ) is pro Embodiment 288. The molecular complex of Embodi line . ment 285 , wherein the amino acid is D - lysine . 25 Embodiment 309 . The molecular complex of Embodi Embodiment 289 . The molecular complex of Embodi ment 285 , wherein the amino acid ( including the DL ment 285 , wherein the amino acid is DL - lysine . mixture , a D - enantiomer , or an L - enantiomer ) is serine . Embodiment 290 . The molecular complex of Embodi Embodiment 310 . The molecular complex of Embodi ment 285 , wherein the amino acid is a glycine . ment 285 , wherein the amino acid ( including the DL Embodiment 291 . The molecular complex of Embodi- 30 mixture , a D - enantiomer, or an L - enantiomer ) is threo ment 285 , wherein the amino acid is L - glycine . nine . Embodiment 292 . The molecular complex of Embodi Embodiment 311 . The molecular complex of Embodi ment 285 , wherein the amino acid is D - glycine . ment 285 , wherein the amino acid ( including the DL Embodiment 293 . The molecular complex of Embodi mixture, a D -enantiomer , or an L - enantiomer ) is tryp ment 285 , wherein the amino acid is DL - glycine . 35 tophan . Embodiment 294 . The molecular complex of Embodi Embodiment 312 . The molecular complex of Embodi ment 283, wherein the amide is nicotinamide . ment 285 , wherein the amino acid ( including the DL Embodiment 295 . The molecular complex of Embodi mixture , a D - enantiomer, or an L - enantiomer ) is tyro ment 283 , wherein the amine is adenine . sine. Embodiment 296 . The molecular complex of Embodi- 40 Embodiment 313 . The molecular complex of Embodi ment 285 , wherein the amino acid ( including the DL ment 285 , wherein the amino acid ( including the DL mixture , a D - enantiomer , or an L - enantiomer ) is ala mixture , a D - enantiomer, or an L - enantiomer ) is valine. nine . Embodiment 314 . A dosage form comprising the molecu Embodiment 297 . The molecular complex of Embodi lar complex of Embodiment 282 , 283 , 284 , 285 , 286 , ment 285 , wherein the amino acid ( including the DL - 45 287 , 288 , 289 , 290 , 291 , 292 , 293 , 294 , 295 , 296 , 297 , mixture , a D - enantiomer , or an L - enantiomer ) is argi 298 , 299 , 300 , 301 , 302 , 303 , 304 , 305, 306 , 307 , 308 , nine . 309 , 310 , 311 , 312 , or 313 . Embodiment 298 . The molecular complex of Embodi- Embodiment 315 . The dosage form of Embodiment 314 , ment 285 , wherein the amino acid ( including the DL which is an oral dosage form . mixture , a D -enantiomer , or an L -enantiomer ) is 50 Embodiment 316 . A method of treating pain , a musculo asparagine . skeletal condition , or a condition related to bone or Embodiment 299 . The molecular complex of Embodi joint comprising administering a dosage form of ment 285, wherein the amino acid ( including the DL Embodiment 314 or 315 to a mammal in need thereof. mixture , a D - enantiomer , or an L -enantiomer ) is aspar Embodiment 317 . The method of Embodiment 316 , tic acid . 55 wherein the mammal is a human being. Embodiment 300 . The molecular complex of Embodi Embodiment 318 . The method of Embodiment 316 or ment 285 , wherein the amino acid ( including the DL 317 , comprising treating acute pain , central pain , radio mixture , a D - enantiomer , or an L - enantiomer) is cys therapy or chemo - therapy associated neuropathy , anky teine . losing spondylitis , arthritis , axial spondyloarthritis , Embodiment 301. The molecular complex of Embodi- 60 blood cancers , bone fracture , bone metastases from ment 285 , wherein the amino acid ( including the DL solid tumors , bone metastasis , breast cancer, cancer, mixture , a D - enantiomer, or an L -enantiomer ) is glu central multiple sclerosis pain , Charcot ' s foot , chronic tamic acid . pain , complex regional pain syndrome, diabetic periph Embodiment 302 . The molecular complex of Embodi eral neuropathy, erosive osteoarthritis , excessive bone ment 285 , wherein the amino acid ( including the DL - 65 resorption , fibrous dysplasia , giant cell tumor of bone , mixture , a D - enantiomer, or an L - enantiomer ) is glu HIV -associated neuropathy, hypercalcemia of malig tamine . nancy , inflammatory pain , juvenile rheumatoid arthri US 10 , 016 , 446 B2 85 86 tis , leukemias, low back pain , lumbar nerve root com Embodiment 335 . The method of Embodiment 332 , com pression , lumbosacral pain , lung cancer , metastatic prising treating knee pain by: bone cancer, monoradiculopathies , multiple myeloma , 1 ) selecting a patient having knee pain , and : musculoskeletal pain , neuropathic arthropaties , neuro a . OARSI Grade O or Kellgren and Lawrence Grade pathic pain , non - articular rheumatism , osteoarthritis , 5 O or Grade 1 of joint space narrowing , or osteogenesis imperfecta , osteoporosis , Paget ' s disease , b . pain intensity of 5 or greater measured using the Paget 's disease of bone, peri -articular disorders, phan 0 - 10 NRS , or 5 cm or greater using the 10 cm tom limb pain , post -herpetic neuralgia , postoperative VAS ; and pain , post -stroke pain , prostate cancer, rheumatoid 2 ) administering the dosage form to the patient. Embodiment 336 . The method of Embodiment 335 , com arthritis , SAPHO syndrome, sero -negative (non -rheu - 10 prising selecting a patient having OARSI Grade 0 or matoid ) arthropathies , solid tumors or cancers , spinal Kellgren and Lawrence Grade 1 or Grade 1 of joint cord injury , systemic lupus erythematosus, transient space narrowing . osteoarthritis of the hip , transient osteoporosis , tran Embodiment 337 . The method of Embodiment 335 , com sient osteoporosis of the hip , trigeminal neuralgia , prising selecting a patient having pain intensity of 5 or tumor induced hypocalcemia , or vertebral crush frac - 15 greater measured using the 0 - 10 NRS , or 5 cm or ture . greater using the 10 cm VAS . Embodiment 319 . The method of Embodiment 316 or Embodiment 338 . The method of Embodiment 335 , 336 , 317 , comprising treating arthritis . or 337 , wherein the patient experiences a reduction in pain intensity - when using a 100 mm visual analog Embodiment 320 . The method of Embodiment 319 , com scale -of at least about 5 mm . prising relieving pain associated with arthritis . Embodiment 339 . The method of Embodiment 316 or Embodiment 321 . The method of Embodiment 320 , 317 , comprising treating musculoskeletal pain . wherein the arthritis affects a knee , an elbow , a wrist , a Embodiment 340 . The method of Embodiment 316 or shoulder , or a hip . 317 , comprising treating inflammatory pain . Embodiment 341 . The method of Embodiment 316 or Embodiment 322 . The method of Embodiment 321, 25 317 , comprising treating back pain . wherein the arthritis affects a knee . Embodiment 342 . The method of Embodiment 341, Embodiment 323 . The method of Embodiment 316 or wherein the back pain comprises low back pain . 317 , comprising treating musculoskeletal pain . Embodiment 343 . The method of Embodiment 342 , Embodiment 324 . The method of Embodiment 316 or wherein the low back pain is related to a vertebral 317 , comprising treating a bone marrow lesion . 30 change . Embodiment 344 . The method of Embodiment 316 or Embodiment 325 . The method of Embodiment 324 , 317 , comprising treating type 1 Modic changes , or type wherein the mammal is a human being that experiences 1 and type 2 Modic changes. a reduction in bone marrow lesion size that is at least Embodiment 345. The method of Embodiment 344 , about 15 % within about 6 months after the inhibitor of 35 wherein the Modic change is located at C1/ 2 , C2 /3 , osteoclast activity is administered to the human being . C3/ 4 , C4 / 5 , C5 /6 , or C6 / 7 . Embodiment 326 . The method of Embodiment 324 , Embodiment 346 . The method of Embodiment 344 , wherein the mammal is a human being that experiences wherein the Modic change is located at C7/ T1 , T1/ 2 , a reduction in bone marrow lesion size that is at least T2 / 3 , T3 / 4 , T4 / 5 , T5 /6 , T6 / 7 , T7 /8 , T8 / 9 , T9 / 10 , T10 / about 25 % within about 6 months after the inhibitor of 40 11 , or T11 / 12 . osteoclast activity is administered to the human being . Embodiment 347 . The method of Embodiment 344 , wherein the Modic change is located at T12 /L1 , L1/ 2 , Embodiment 327 . The method of Embodiment 324 , 325 , L2/ 3 , L3 / 4 , L4 / 5 , or L5 /S1 . or 326 , wherein the bone marrow lesion affects a knee . Embodiment 348 . The method of Embodiment 316 or Embodiment 328 . The method of Embodiment 324 , 325 , 317 , comprising treating pain in an extremity . 326 , or 327 , comprising treating a bone marrow lesion 45 Embodiment 349 . The method of Embodiment 316 or of the knee by selecting a patient having a bone marrow 317 , comprising treating joint pain . lesion of the knee and OARSIGrade 0 or Kellgren and Embodiment 350 . The method of Embodiment 316 or Lawrence Grade 0 or Grade 1 of joint space narrowing , 317 , comprising treating muscle pain . and administering the dosage form to the patient for the Embodiment 351 . The method of Embodiment 316 or treatment of the bone marrow lesion . 317 , comprising treating neuropathic pain . Embodiment 352 . The method of Embodiment 316 or Embodiment 329 . The method of Embodiment 316 or 317 , comprising treating complex regional pain syn 317 , comprising treating osteoarthritis . drome. Embodiment 330 . The method of Embodiment 329 , Embodiment 353 . The method of Embodiment 352 , wherein the osteoarthritis affects a knee . 55 wherein the complex regional pain syndrome is com Embodiment 331 . The method of Embodiment 329 or plex regional pain syndrome type I. 330 , comprising treating an osteolytic lesion associated Embodiment 354 . The method of Embodiment 352 , wherein the complex regional pain syndrome is com with osteoarthritis . plex regional pain syndrome type II. Embodiment 332 . The method of Embodiment 316 , 317 , Embodiment 355 . The method of Embodiment 316 or 318 , 319 , 320 , 321, 322, 323 , 324 , 325, 326 , 327 , 328 , 317 , comprising treating Paget' s disease of bone . 329 , 330 , or 331, comprising treating knee pain . Embodiment 356 . The method of Embodiment 316 or Embodiment 333 . The method of Embodiment 332 , com 317 , comprising treating multiple myeloma. prising treating moderate to severe knee pain . Embodiment 357 . The method of Embodiment 316 or Embodiment 334 . The method of Embodiment 332 or 65 317 , comprising treating ankylosing spondylitis . 333 , wherein the mammal is a human being that has a Embodiment 358 . The method of Embodiment 316 , 317 , normal joint space in the knee . 318 , 319 , 320 , 321 , 322 , 323 , 324 , 325 , 326 , 327 , 328 , US 10 ,016 ,446 B2 87 88 329 , 330 , 331, 332, 333, 334 , 335 , 336 , 337, 338 , 339, 340 , 341, 342 , 343 , 344 , 345 , 346 , 347 , 348 , 349 , 350 , 340 , 341 , 342 , 343 , 344 , 345 , 346 , 347 , 348 , 349 , 350 , 351, 352 , 353 , 354 , 355 , 356 , 357 , 358 , 359 , 360 , 361 , 351 , 352 , 353 , 354 , 355 , 356 , or 357 , wherein the 362, 363, 364, 365 , 366 , or 367 , wherein the compound dosage form is administered about every three months, is administered more than once . or more frequently . 5 Embodiment 369 . The method , composition , molecular Embodiment 359 . The method of Embodiment 316 , 317 , complex , dosage form , or product, of any preceding 318 , 319 , 320 , 321, 322 , 323 , 324 , 325 , 326 , 327 , 328 , 329 , 330 , 331 , 332 , 333 , 334 , 335 , 336 , 337 , 338 , 339 , embodiment, wherein zoledronic acid or neridronic 340 , 341 , 342 , 343 , 344 , 345 , 346 , 347 , 348 , 349, 350 , acid decreases osteoclast activity and / or CTX serum 351 , 352 , 353 , 354 , 355 , 356 , 357 , or 358 , wherein the 10 levels . mammal experiences pain relief at least 24 hours after Embodiment 370 . The method , composition , molecular the dosage form is administered to the mammal. complex , dosage form , or product , of any preceding Embodiment 360 . The method of Embodiment 316 , 317 , embodiment, wherein zoledronic acid or neridronic 318 , 319 , 320 , 321, 322 , 323 , 324 , 325 , 326 , 327 , 328 , acid decreases osteoclast activity by at least about 5 % . 329 , 330 , 331 , 332 , 333 , 334 , 335 , 336 , 337 , 338 , 339 , 15 Embodiment 371. The method , composition , molecular 340 , 341, 342 , 343 , 344 , 345 , 346 , 347 , 348 , 349, 350 , complex , dosage form , or product , of any preceding 351 , 352 , 353 , 354 , 355 , 356 , 357 , 358 , or 359 , wherein embodiment, wherein zoledronic acid or neridronic the mammal experiences pain relief three months after acid decreases osteoclast activity by at least about 10 % . the dosage form is administered . Embodiment 372 . The method , composition , molecular Embodiment 361 . The method of Embodiment 316 , 317 , 20 complex , dosage form , or product, of any preceding 318 , 319 , 320 , 321 , 322 , 323 , 324 , 325 , 326 , 327 , 328 , embodiment, wherein zoledronic acid or neridronic 329 , 330 , 331 , 332 , 333 , 334 , 335 , 336 , 337 , 338 , 339 , acid decreases osteoclast activity by at least about 15 % . 340 , 341 , 342 , 343 , 344 , 345 , 346 , 347 , 348 , 349 , 350 , Embodiment 373. The method, composition , molecular 351 , 352 , 353, 354 , 355 , 356 , 357 , 358 , 359 , or 360 , complex , dosage form , or product , of any preceding wherein the human being experiences pain relief that 25 embodiment , wherein zoledronic acid or neridronic lasts for a duration of at least 48 hours after adminis acid decreases osteoclast activity by at least about 20 % . tration of the dosage form . Embodiment 374 . The method , composition , molecular Embodiment 362 . The method of Embodiment 316 , 317 , complex , dosage form , or product , of any preceding 318 , 319 , 320 , 321 , 322 , 323 , 324 , 325 , 326 , 327 , 328 , embodiment, wherein zoledronic acid or neridronic 329 , 330 , 331, 332 , 333 , 334 , 335 , 336 , 337 , 338 , 339 , 30 acid decreases osteoclast activity by at least about 25 % . 340 , 341 , 342 , 343 , 344 , 345 , 346 , 347 , 348 , 349 , 350 , Embodiment 375 . The method , composition , molecular 351, 352 , 353 , 354 , 355 , 356 , 357 , 358 , 359 , 360 , or complex , dosage form , or product, of any preceding 361, wherein thehuman being receives the dosage form embodiment, wherein zoledronic acid or neridronic no more often than once daily . acid decreases osteoclast activity by at least about 30 % . Embodiment 363 . The method of Embodiment 316 , 317 , 35 Embodiment 376 . The method , composition , molecular 318 , 319 , 320 , 321 , 322 , 323 , 324 , 325 , 326 , 327 , 328 , complex , dosage form , or product , of any preceding 329 , 330 , 331, 332 , 333 , 334 , 335 , 336 , 337 , 338 , 339 , embodiment, wherein zoledronic acid or neridronic 340 , 341, 342 , 343 , 344 , 345 , 346 , 347 , 348 , 349, 350 , acid decreases osteoclast activity by at least about 35 % . 351 , 352 , 353 , 354 , 355 , 356 , 357 , 358 , 359 , 360 , or Embodiment 377 . The method , composition , molecular 361, wherein there is a period of about 24 hours to 40 complex , dosage form , or product, of any preceding about 7 days between administration of dosage forms. embodiment, wherein zoledronic acid or neridronic Embodiment 364 . The method of Embodiment 363 , acid decreases osteoclast activity by at least about 40 % . wherein the dosage form is administered weekly. Embodiment 378 . The method , composition , molecular Embodiment 365 . The method of Embodiment 316 , 317 , complex , dosage form , or product , of any preceding 318 , 319 , 320 , 321 , 322 , 323 , 324 , 325 , 326 , 327 , 328 , 45 embodiment , wherein zoledronic acid or neridronic 329, 330 , 331, 332 , 333 , 334 , 335 , 336 , 337 , 338 , 339 , acid decreases osteoclast activity by at least about 45 % . 340 , 341 , 342 , 343 , 344 , 345 , 346 , 347 , 348 , 349 , 350 , Embodiment 379 . The method , composition , molecular 351 , 352 , 353, 354 , 355 , 356 , 357 , 358 , 359, 360 , or complex , dosage form , or product, of any preceding 361, wherein there is a period of about 14 days to about embodiment , wherein zoledronic acid or neridronic 28 days between administration of dosage forms. 50 acid decreases osteoclast activity by at least about 50 % . Embodiment 366 . The method of Embodiment 316 , 317 , Embodiment 380 . The method , composition , molecular 318 , 319 , 320 , 321 , 322 , 323 , 324 , 325 , 326 , 327 , 328 , complex , dosage form , or product, of any preceding 329 , 330 , 331 , 332, 333 , 334 , 335 , 336 , 337, 338 , 339 , embodiment, wherein zoledronic acid or neridronic 340 , 341, 342 , 343 , 344 , 345 , 346 , 347 , 348 , 349 , 350 , acid decreases osteoclast activity by at least about 55 % . 351, 352 , 353 , 354 , 355 , 356 , 357, 358 , 359 , 360 , or 55 Embodiment 381. The method , composition , molecular 361 , wherein there is a period of at least one month complex , dosage form , or product, of any preceding between administration of dosage forms. embodiment, wherein zoledronic acid or neridronic Embodiment 367 . The method of Embodiment 316 , 317 , acid decreases osteoclast activity by at least about 60 % . 318 , 319 , 320 , 321 , 322 , 323 , 324 , 325 , 326 , 327 , 328 , Embodiment 382 . The method , composition , molecular 329, 330 , 331, 332 , 333 , 334 , 335 , 336 , 337 , 338 , 339 , 60 complex , dosage form , or product , of any preceding 340 , 341 , 342 , 343 , 344 , 345 , 346 , 347 , 348 , 349 , 350 , embodiment, wherein zoledronic acid or neridronic 351, 352 , 353, 354 , 355 , 356 , 357 , 358 , 359 , 360 , or acid decreases osteoclast activity by at about 60 % 361 , wherein there is a period of about 7 days to about 70 % . 14 days between administration of dosage forms. Embodiment 383 . The method , composition , molecular Embodiment 368 . The method of Embodiment 316 , 317 , 65 complex , dosage form , or product, of any preceding 318 , 319 , 320 , 321, 322 , 323 , 324 , 325 , 326 , 327 , 328 , embodiment, wherein zoledronic acid or neridronic 329 , 330 , 331 , 332 , 333 , 334 , 335 , 336 , 337 , 338 , 339 , acid decreases osteoclast activity by about 70 % - 80 % . US 10 ,016 ,446 B2 89 90 Embodiment 384 . The method , composition , molecular embodiment, wherein zoledronic acid or neridronic complex , dosage form , or product , of any preceding acid decreases CTX serum levels by at least about 20 % . embodiment, wherein zoledronic acid or neridronic Embodiment 401 . The method, composition , molecular acid decreases osteoclast activity by at least about 70 % . complex , dosage form , or product, of any preceding Embodiment 385 . The method , composition , molecular 5 embodiment, wherein zoledronic acid or neridronic complex , dosage form , or product, of any preceding acid decreases CTX serum levels by at least about 25 % . embodiment, wherein zoledronic acid or neridronic Embodiment 402 . The method , composition , molecular acid decreases osteoclast activity by at about 75 % . complex , dosage form , or product , of any preceding Embodiment 386 . The method , composition , molecular embodiment, wherein zoledronic acid or neridronic complex , dosage form , or product, of any preceding 10 acid decreases CTX serum levels by at least about 30 % . embodiment, wherein zoledronic acid or neridronic acid decreases osteoclast activity by about 80 % - 90 % . Embodiment 403 . The method , composition , molecular Embodiment 387 . The method , composition , molecular complex , dosage form , or product, of any preceding complex , dosage form , or product , of any preceding embodiment, wherein zoledronic acid or neridronic embodiment, wherein zoledronic acid or neridronic 15 acid decreases CTX serum levels by at least about 35 % . acid decreases osteoclast activity by at least about 80 % . Embodiment 404 . The method , composition , molecular Embodiment 388 . The method , composition , molecular complex , dosage form , or product, of any preceding complex , dosage form , or product, of any preceding embodiment, wherein zoledronic acid or neridronic embodiment, wherein zoledronic acid or neridronic acid decreases CTX serum levels by at least about 40 % . acid decreases osteoclast activity by at least about 85 % . 20 Embodiment 405. The method , composition , molecular Embodiment 389 . The method , composition , molecular complex , dosage form , or product, of any preceding complex , dosage form , or product, of any preceding embodiment, wherein zoledronic acid or neridronic embodiment, wherein zoledronic acid or neridronic acid decreases CTX serum levels by at least about 45 % . acid decreases osteoclast activity by about 80 % - 85 % . Embodiment 406 . The method, composition , molecular Embodiment 390 . The method , composition , molecular 25 complex , dosage form , or product, of any preceding complex , dosage form , or product , of any preceding embodiment, wherein zoledronic acid or neridronic embodiment, wherein zoledronic acid or neridronic acid decreases CTX serum levels by at least about 50 % . acid decreases osteoclast activity by at least about 90 % . Embodiment 407 . The method , composition , molecular Embodiment 391. The method , composition , molecular complex , dosage form , or product, of any preceding complex , dosage form , or product, of any preceding 30 embodiment, wherein zoledronic acid or neridronic embodiment, wherein zoledronic acid or neridronic acid decreases CTX serum levels by at least about 55 % . acid decreases osteoclast activity by about 85 % - 90 % . Embodiment 408 . The method , composition , molecular Embodiment 392 . The method, composition , molecular complex , dosage form , or product, of any preceding complex , dosage form , or product , of any preceding embodiment, wherein zoledronic acid or neridronic embodiment, wherein zoledronic acid or neridronic 35 acid decreases CTX serum levels by at least about 60 % . acid decreases osteoclast activity by about 85 % - 95 % . Embodiment 409 . The method , composition , molecular Embodiment 393 . The method , composition , molecular complex , dosage form , or product , of any preceding complex , dosage form , or product, of any preceding embodiment , wherein zoledronic acid or neridronic embodiment, wherein zoledronic acid or neridronic acid decreases CTX serum levels by about 60 % -70 % . acid decreases osteoclast activity by about 90 % - 95 % . 40 Embodiment 410 . The method , composition , molecular Embodiment 394 . The method , composition , molecular complex , dosage form , or product, of any preceding complex , dosage form , or product, of any preceding embodiment, wherein zoledronic acid or neridronic embodiment, wherein zoledronic acid or neridronic acid decreases CTX serum levels by about 70 % -80 % . acid decreases osteoclast activity by at least about 95 % . Embodiment 411. The method , composition , molecular Embodiment 395 . The method , composition , molecular 45 complex , dosage form , or product, of any preceding complex , dosage form , or product, of any preceding embodiment, wherein zoledronic acid or neridronic embodiment, wherein zoledronic acid or neridronic acid decreases CTX serum levels by least about 70 % . acid decreases osteoclast activity by at least about 99 % . Embodiment 412 . The method , composition , molecular Embodiment 396 . The method , composition , molecular complex , dosage form , or product, of any preceding complex , dosage form , or product, of any preceding 50 embodiment, wherein zoledronic acid or neridronic embodiment, wherein zoledronic acid or neridronic acid decreases CTX serum levels by at least about 75 % . acid decreases osteoclast activity by at least about Embodiment 413 . The method , composition , molecular 100 % . complex , dosage form , or product, of any preceding Embodiment 397 . The method , composition , molecular embodiment , wherein zoledronic acid or neridronic complex , dosage form , or product, of any preceding 55 acid decreases CTX serum levels by at least about 80 % . embodiment, wherein zoledronic acid or neridronic Embodiment 414 . The method , composition , molecular acid decreases CTX serum levels by at least about 5 % . complex , dosage form , or product, of any preceding Embodiment 398 . The method, composition , molecular embodiment, wherein zoledronic acid or neridronic complex , dosage form , or product, of any preceding acid decreases CTX serum levels by at least about 85 % . embodiment, wherein zoledronic acid or neridronic 60 Embodiment 415 . The method , composition , molecular acid decreases CTX serum levels by at least about 10 % . complex , dosage form , or product, of any preceding Embodiment 399 . The method , composition , molecular embodiment, wherein zoledronic acid or neridronic complex , dosage form , or product , of any preceding acid decreases CTX serum levels by about 80 % -85 % . embodiment, wherein zoledronic acid or neridronic Embodiment 416 . The method , composition , molecular acid decreases CTX serum levels by at least about 15 % . 65 complex , dosage form , or product , of any preceding Embodiment 400 . The method , composition , molecular embodiment, wherein zoledronic acid or neridronic complex , dosage form , or product, of any preceding acid decreases CTX serum levels by at least about 90 % . US 10 ,016 ,446 B2 91 92 Embodiment 417 . The method , composition , molecular other elements found herein . It is anticipated that one or complex , dosage form , or product , of any preceding more members of a group may be included in , or deleted embodiment, wherein zoledronic acid or neridronic from , a group for reasons of convenience and /or patentabil acid decreases CTX serum levels by about 80 % - 90 % . ity. When any such inclusion or deletion occurs , the speci Embodiment 418 . The method , composition , molecular 5 fication is deemed to contain the group as modified thus complex , dosage form , or product, of any preceding fulfilling the written description of all Markush groups used embodiment, wherein zoledronic acid or neridronic in the appended claims. acid decreases CTX serum levels by about 85 % -90 % . Certain embodiments are described herein , including the Embodiment 419 . The method, composition , molecular best mode known to the inventors for carrying out the complex , dosage form , or product , of any preceding 10 invention . Of course , variations on these described embodi embodiment, wherein zoledronic acid or neridronic ments will become apparent to those of ordinary skill in the acid decreases CTX serum levels by about 85 % - 95 % . art upon reading the foregoing description . The inventor Embodiment 420 . The method , composition , molecular expects skilled artisans to employ such variations as appro complex , dosage form , or product, of any preceding priate , and the inventors intend for the invention to be embodiment, wherein zoledronic acid or neridronic 15 practiced otherwise than specifically described herein . acid decreases CTX serum levels by about 90 % - 95 % . Accordingly , the claims include all modifications and Embodiment 421. The method , composition , molecular equivalents of the subject matter recited in the claims as complex , dosage form , or product, of any preceding permitted by applicable law . Moreover , any combination of embodiment , wherein zoledronic acid or neridronic the above -described elements in all possible variations acid decreases CTX serum levels by at least about 95 % . 20 thereof is contemplated unless otherwise indicated herein or Embodiment 422 . The method , composition , molecular otherwise clearly contradicted by context. complex , dosage form , or product , of any preceding In closing, it is to be understood that the embodiments embodiment, wherein zoledronic acid or neridronic disclosed herein are illustrative of the principles of the acid decreases CTX serum levels by at least about 99 % . claims. Other modifications that may be employed are Embodiment 423 . The method , composition , molecular 25 within the scope of the claims. Thus, by way of example , but complex , dosage form , or product, of any preceding not of limitation , alternative embodiments may be utilized in embodiment, wherein zoledronic acid or neridronic accordance with the teachings herein . Accordingly , the acid decreases CTX serum levels by at least about claims are not limited to embodiments precisely as shown 100 % . and described . Embodiment 424 . The method , dosage form , or product , 30 What is claimed is : of any preceding embodiment , wherein the zoledronic 1 . A method of treating pain associated with Paget ' s acid is orally administered in a manner that results in a disease of bone , comprising orally administering zoledronic 24 hour sustained plasma level factor that is at least 1 . 5 acid in a disodium salt form to a human being in need times that of 4 mg of zoledronic acid administered thereof, wherein the zoledronic acid in the disodium salt intravenously . 35 form is orally administered in a dosage form that does not Unless otherwise indicated , all numbers expressing quan - contain a bioavailability enhancer, wherein the human being tities of ingredients , properties such as molecular weight, receives a total dose of the zoledronic acid in the disodium reaction conditions , and so forth used in the specification salt form in a month that is about 100 mg to about 500 mg; and claims are to be understood in all instances as indicating and wherein the zoledronic acid in the disodium salt form both the exact values as shown and as being modified by the 40 enhances bioavailability of zoledronic acid as determined by term " about. ” Accordingly , unless indicated to the contrary , the following test: the numerical parameters set forth in the specification and comparing the area under the curve of the plasma con attached claims are approximations thatmay vary depending centration (AUC ) of zoledronic acid resulting from upon the desired properties sought to be obtained . At the orally administering the dosage form to a beagle dog to very least, and not as an attempt to limit the application of 45 the area under the curve of the plasma concentration of the doctrine of equivalents to the scope of the claims, each zoledronic acid resulting from orally administering a numerical parameter should at least be construed in light of reference dosage form to a beagle dog , the number of reported significant digits and by applying wherein the reference dosage form contains same molar ordinary rounding techniques . amount of zoledronic acid in the diacid form instead of The terms “ a , " " an , ” “ the ” and similar referents used in 50 zoledronic acid in the disodium salt form . the context of describing the invention (especially in the 2 . The method of claim 1 , wherein each orally adminis context of the following claims) are to be construed to cover tered dose contains about 50 mg to about 60 mg of the both the singular and the plural, unless otherwise indicated zoledronic acid in the disodium salt form . herein or clearly contradicted by context. All methods 3 . The method of claim 1 , wherein the zoledronic acid in described herein can be performed in any suitable order 55 the disodium salt form is orally administered at an interval unless otherwise indicated herein or otherwise clearly con - of about 5 to 10 days . tradicted by context. The use of any and all examples , or 4 . The method of claim 2 , wherein the zoledronic acid in exemplary language ( e . g . , " such as ” ) provided herein is the disodium salt form is orally administered about once a intended merely to better illuminate the invention and does week . not pose a limitation on the scope of any claim . No language 60 5 . The method of claim 1 , wherein each orally adminis in the specification should be construed as indicating any tered dose of the zoledronic acid in the disodium salt form non -claimed element essential to the practice of the inven - is orally administered in a manner that provides an AUC of tion. zoledronic acid of about 140 ng -h /mL to about 150 ng - h /mL , Groupings of alternative elements or embodiments dis - measured over a 24 hour period . closed herein are not to be construed as limitations . Each 65 6 . The method of claim 4 , wherein each orally adminis group member may be referred to and claimed individually tered dose of the zoledronic acid in the disodium salt form or in any combination with other members of the group or is orally administered in a manner that provides an AUC of US 10 ,016 , 446 B2 93 94 zoledronic acid ofabout 130 ng -h /mL to about 150 ng- h /mL , that results in a bioavailability of zoledronic acid in the measured over a 24 hour period . human being of about 1 .4 % to about 1. 8 % . 7 . The method of claim 1 , wherein the human being 20 . The method of claim 15 , wherein the zoledronic acid in the disodium salt form is orally administered in a manner experiences significant pain relief for a period of at least 5 that results in a bioavailability of zoledronic acid in the about 24 hours . human being of about 1 . 8 % to about 2 % . 8 . The method of claim 1 , wherein the human being 21 . The method of claim 15 , wherein the zoledronic acid experiences significant pain relief for a period of at least in the disodium salt form is orally administered in a manner about 1 week . that results in a bioavailability of zoledronic acid in the 9 . The method of claim 1 , wherein each orally adminis human being of about 2 % to about 2 . 2 % . tered dose contains about 55 mg to about 60 mg of the 22 . The method of claim 15 , wherein the zoledronic acid zoledronic acid in the disodium salt form . in the disodium salt form is orally administered in a manner 10 . The method of claim 1 , wherein the human being that results in a bioavailability of zoledronic acid in the experiences significant pain relief for a period of at least 1 human being of about 2 . 2 % to about 2 . 4 % . month . 23 . The method of claim 15 , wherein the zoledronic acid 11 . The method of claim 1 , wherein the zoledronic acid in 15 in the disodium salt form is orally administered in a manner the disodium salt form is orally administered about once a that results in a bioavailability of zoledronic acid in the week for 6 weeks . human being of about 2 . 4 % to about 2 . 8 % . 12 . The method of claim 1 , wherein the zoledronic acid in 24 . The method of claim 15 , wherein the zoledronic acid the disodium salt form is orally administered about once a 20 in the disodium salt form is orally administered in a manner week for 3 weeks. 20 that results in a bioavailability of zoledronic acid in the 13 . The method of claim 1 , wherein the human being human being of about 2 . 8 % to about 3 . 2 % . experiences significant pain relief at 3 months after the first 25 . The method of claim 5 , wherein the zoledronic acid in dose of the zoledronic acid in the disodium salt form is the disodium salt form is administered at least 2 times in 3 administered . months. 14. The method of claim 1, wherein the human being 25 26 . The method of claim 1, wherein administering the experiences significant pain relief at 6 months after the first zoledronic acid in the disodium salt form to the human being dose of the zoledronic acid in the disodium salt form is reduces the use of a nonsteroidal antiinflammatory drug or administered an opioid by at least about 25 % as compared to the use of 15 . The method of claim 13 , wherein the zoledronic acid 30 the nonsteroidal antiinflammatory drug or the opioid with in the disodium salt form is orally administered in a dosage 30 out administration of the zoledronic acid in the disodium salt form that contains at least about 20 % of the zoledronic acid form . in the disodium salt form by weight. 27 . The method of claim 9 , wherein the zoledronic acid in 16 . The method of claim 1 , wherein the human being the disodium salt form is orally administered once a week experiences significant pain relief that lasts for a period of at 35 for 6 weeks. least 1 year . 35 28 . The method of claim 1 , wherein the zoledronic acid in 17. The method of claim 13, wherein the zoledronic acid the disodium salt form is co -administered with a steroid . in the disodium salt form is orally administered in a dosage 29 . Themethod of claim 1 , wherein the zoledronic acid in form that contains at least about 50 % of the zoledronic acid the disodium salt form is orally administered in a manner in the disodium salt form by weight. that results in a reduction of serum alkaline phosphatase 18 . The method of claim 1 , wherein the human being 40 (ALPALP )) |level of at least about 50 % from baseline . experiences significantpain relief that lasts for a period of at 30 . The method of claim 1 , wherein the Paget ' s disease of least 5 years . bone does not return within 18 months from the time of the 19 . The method of claim 15, wherein the zoledronic acid last oral administration of zoledroniac acid . in the disodium salt form is orally administered in a manner * * * * *