Bisphosphonates as a Countermeasure to Space Flight Induced Bone Loss: SMO-021

The purpose of this Supplementary Medical Objective is to determine whether bisphosphonates, in conjunction with the routine in-flight exercise program, will protect International Space Station (ISS) crewmembers from the regional decreases in bone mineral density documented on previous ISS flights. Two dosing regimens will be tested: (1) an oral dose of 70 mg alendronate taken weekly during flight and (2) and I.V. dose of zoledronic acid 4 mg, administered just once approximately 45 days before flight. Our rationale for including both alendronate and zoledronic acid is that two dosing options will: maximize crew participation, increase the countermeasure options available to flight surgeons, increase scientific opportunities, and minimize the effects of operational and logistical constraints. Use of both oral and I.V. options can accommodate both crew and flight surgeon preferences (e.g., based on individual drug sensitivity, relevant health conditions, or other considerations). Operational and logistical constraints may favor one option versus the other. For example, stowage limits may limit use of alendronate on certain flights, while the ability to titrate the in-flight dose in response to on-orbit measurements of bone resorption would favor the weekly dosing regimen. Long-duration (e.g., 2+ year) missions would require in-flight re-dosing of I.V. zoledronic acid. The purpose of this study is not to test one dosing option versus the other. Rather, we intend to show that bisphosphonates-plus-exercise will have a measurable effect versus exercise alone in preventing space flight induced bone loss. Secondary goals will be to document the return to normal bone remodeling post-flight in crewmembers who took bisphosphonates.

See also https://www.nasa.gov/mission_pages/station/research/experiments/explorer/Investigation.html?#id=232

While the primary purpose of this research is to develop a countermeasure to protect crewmembers against bone loss during long duration space flight, this research may provide insight into the mechanisms and prevention of bone atrophy in other disuse conditions.

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