Bisphosphonates for Osteoporosis

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Kashif Munir, M.D.

Additional Resources
Mayo Clinic
National Osteoporosis Foundation

What are bisphosphonates and what are their benefits?

Bisphosphonates are the kind of medicine used most often to treat osteoporosis. They prevent bones from getting weaker by slowing the natural breakdown of bone. Bisphosphonates lower the risk of spine fractures and most lower the risk of hip fracture as well.

Several types of bisphosphonates are available, in pill or liquid form. Some are given intravenously (IV), which means the medicine is injected into a vein at the doctor’s office or a hospital.

What side effects do bisphosphonates have?

Side effects of bisphosphonates can include:

  • Nausea, heartburn, swallowing problems, or irritation of the esophagus (the tube that carries food and liquid from your mouth to your stomach)
  • Pain in the muscles, joints, bones, or stomach

Some people have reported serious side effects, but studies have shown that these are very rare:

  • ONJ (osteonecrosis of the jaw), a severe breakdown of bone in the jaw, usually after a major dental procedure
  • Fractures of the thigh bone

What can you do about side effects?

If you take a bisphosphonate and you’re having side effects, tell your doctor. Your doctor might give you a different kind of medicine to overcome the side effects. For example, taking medicine through an IV instead of swallowing a pill can overcome heartburn.

You can prevent serious problems by:

  • Telling your doctor about health problems you’ve had in the past (to help the doctor choose the best medicine for you)
  • Telling your doctor about dental problems or dental surgery
  • Calling your doctor if you have unusual pain in your thigh or hip
  • Always taking your medicine as instructed
  • Having regular checkups

Other medicines for osteoporosis include:

  • Denosumab, a medicine that slows bone breakdown and reduces the risk of fractures, including hip fractures
  • Estrogen, a hormone that slows bone breakdown (used only by women who already take it to treat menopausal symptoms)
  • Raloxifene, a medicine that slows bone breakdown and reduces the risk of some types of fractures
  • Teriparatide, a medicine that stimulates new bone growth and reduces the risk of some types of fractures
  • Calcitonin, a hormone that slows bone loss

Your doctor can talk with you about the risks and benefits of each of these medicines.

What do experts say about taking bisphosphonates?

Experts say that the benefits of taking bisphosphonates outweigh the risks for most people with osteoporosis. Overall, when you take this type of medicine, your chance of preventing fractures is high, and the risk of serious problems is low.

Questions to ask your doctor

  • Do I need medicines for osteoporosis?
  • What type of medicine do I need?
  • What are the risk and benefits of my medicine?
  • How often should I have a bone density test?
  • Should I take calcium and vitamin D supplements? How much do I need?
  • What else can I do to keep my bones strong?
  • Should I see an endocrinologist?

Edited: September 2017