Bisphosphonates for Osteoporosis

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 and other kinds of fractures 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. Denosumab is given by your doctor as an injection under your skin every six months. 
  • 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. Raloxifene is a pill that you take every day.
  • Teriparatide, a medicine that stimulates new bone growth and reduces the risk of some types of fractures. You give yourself an injection every day for as long as two years - and then continue treatment with another kind of medicine designed to prevent bone loss.
  • Abaloparatide, another medicine that stimulates new bone growth and reduces the risk of fractures. It is also given as a self-administered injection for as long as two years, with plans to follow that treatment with another medicine intended to prevent bone loss.
  • Calcitonin, a hormone that slows bone loss. Calcitonin is usually given as a nasal spray each day.
  • Romosozumab, a medicine that also stimulates new bone growth and reduces the risk of fractures.Romosozumab is given by your doctor as a monthly injection for twelve months, again with plans to then follow that treatment with medicine to prevent bone breakdown.
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 greatly 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.

← More about Medicine Induced Bone Loss

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?
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