Bisphosphonates: Things You Need To Know

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Bisphosphonates are a class of medication used to treat bone disorders. They work by slowing down the cells that break your bones down and put you at risk for bone fractures. This allows the cells responsible for building your bones up to work more efficiently. They are commonly prescribed to adults taking steroids such as Prednisone, which comes with a moderate-to-severe risk of bone fractures, or loss of bone density. However, as with all medications, there are side effects, so make sure you discuss all risks and rewards with your doctor.

As with all medications, follow all of your doctor’s instructions and all instructions that come with your medication to mitigate your risk of experiencing side effects. The scope of this article is to cover what bisphosphonates are, how to take them, who should take them, and everything else you need to know about this medication.

What Are Bisphosphonates?


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Bisphosphonates are medications used to treat bone diseases. They are divided into two classes with different mechanisms to kill osteoclast cells. Nitrogenous bisphoshphonates include alendronate, zoledronate and pamidronate. Non-nitrogenous bisphosphonates include tiludronate, clodronate and etidronate. Risedronate and Alendronate are the two bisphosphonates prescribed most commonly to treat osteoporosis. They work by slowing down osteoclasts, the cells that break down your bone. This improves the efficiency of osteoblasts, the cells that create bone matter. The programmed cell death of osteoclasts is known as apoptosis and significantly slows the decrease of bone density.

FDA-Approved Name Brands

Name brand bisphosphonates include Didronel (etidronate), Fosamax (alendronate), Actonel (risedronate), Boniva (ibandronate), Reclast (zolendronic acid) and Binosto (alendronate sodium). FDA-approved generic medications include Generic Didronel, Generic Fosamax, Generic Boniva, Generic Reclast and Generic Actonel. Binosto must be purchased as a name-brand medication.


These medications are typically taken as weekly or daily tablets, but they may also be taken as quarterly injections. For osteoporosis, individuals typically take these medications for five years or more. If you suffer from Paget’s disease, you may be given this medication for a much shorter period of time. Try to wait 30 minutes to two hours after the administration of your dose before taking any other medication. This is because this medication is hard to absorb.

How To Take Bisphosphonates

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When taking bisphosphonates, follow all recommendations provided by your doctor and all instructions on the bottle. Take this medication as soon as you wake up on an empty stomach. Take it with a full eight ounces of water. Avoid all other beverages including coffee, orange juice and grapefruit juice. Abstain from drinking or eating anything else for at least 30 minutes. Remain upright either standing or sitting for 30 minutes after taking your medication.

Length Of Treatment

Doctors commonly recommend you take this medication for at least three to five years. At this point, your condition will be reviewed to determine if your condition is sufficiently improved or you need to continue taking the medication. Follow your doctor’s professional recommendation. Research suggests the medication keeps affecting the bone for several years after you stop taking it. More research is being conducted on the long-term effects of this medication.


It takes several months for this medication to take effect. Expect to see an increase in bone density between six months and a year after starting to take this medication. These medications do not completely eliminate your risk of bone fractures but they greatly reduce the likelihood of these breaks. They are often prescribed if you have inadequate bone density of the spine, wrist, and hip as these bones are prone to breaking. Osteoporosis accounts for 300,000 hip fractures and 700,000 spinal fractures annually in the United States alone. Approximately 25% of men and 50% of women over the age of 50 will experience a bone fracture related to osteoporosis in their lifetime.

Are Bisphosphonates Right For Me?

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Bisphosphonates are right for those who suffer from osteoporosis or have already experienced a bone fracture (broken bone). This medication will help to prevent any additional broken bones. Doctors also prescribe these medications to those with a high susceptibility for bone fractures and a lack of bone density. Do not take this medication if you are pregnant, nursing, or planning to become pregnant. This medication is not right for those who suffer from hypocalcemia (a low concentration of calcium in your blood), cannot remain upright for 30 minutes after taking the medication, or have poorly functioning kidneys. Other indications this medication is a poor fit for you include: an uncorrected vitamin D deficiency, structural esophageal issues such as Barrett’s esophagus, or a narrow esophagus. Such structural issues decrease the length of time it takes the medication to reach your stomach. Let your doctor know if you suffer from duodenal or stomach ulcers or inflammation of your upper stomach recently. He may recommend you wait before starting to take this medication.


When taking this type of medication, have regular dental check-ups, take vitamin D and calcium supplements, do not take any other medications which may affect these, and follow your doctor’s recommendations for what to do if you have heartburn, difficulty swallowing, or forget to take your medication. If you forget to take your weekly tablet, take it when you remember and then continue to stick to your schedule. Do not take three or more tablets within a 24-hour period. If you forget to take your daily tablet, skip it for the day and then continue on your regular schedule. If you forget your monthly tablet and are due for your next dose within seven days, take a second tablet on the next day you are scheduled to take one. If you are due to take your next monthly tablet in more than seven days, take it when you remember.

Dental Check-Ups

Let your dentist know you are taking bisphosphonate. If you can afford it, have a check-up before starting this medication. In extremely rare cases, the jawbone can receive inadequate blood flow which causes the bone to weaken and die. It is often painful. To prevent the death of the bone, stop taking the medication.

Vitamin D And Calcium

Your bones are built by calcium and vitamin D, so your doctor will probably prescribe vitamin D and calcium supplements, or one or the other. Such supplements come in the form of sachets, effervescent tablets and chewable tablets. Give your doctor an accurate description of your diet. An excess of calcium can cause hypercalcemia, the condition of having an excess of calcium in your bloodstream. These supplements are normally taken daily no matter how frequently you take your bisphosphonate. However, if you take a bisphosphonate daily, take your supplement or supplements at a different time of day.

Other Medications

Bisphosphonate can interact negatively with certain medications you may be taking currently. Advise your doctor of any medications you are taking, including prescribed and over-the-counter medications. Always ask your local pharmacist before purchasing painkillers such as aspirin or ibuprofen as they can irritate your esophagus when taken with a bisphosphonate.

Heartburn Or Difficulty Swallowing

If you experience difficulty swallowing, chest pain, new or worsened heartburn, or painful swallowing, stop taking your bisphosphonate and call your doctor for advice. He may recommend you take a different bisphosphonate or an alternate medicine to mitigate the risk of bone fractures.

Side Effects

The long-term side effects of bisphosphonates have been well researched, and it is safe for long-term use. The most commonly reported side effects are joint or muscle aches, heartburn, or an upset stomach. To mitigate the risk of stomach upset or heartburn, take the medication on an empty stomach and a full glass of water. Very rare side effects include atypical femur fractures and ONJ (osteonecrosis of the jaw). Other side effects include mouth ulcers, headache, and dizziness.


Benefits of this class of medication include the reduction of bone pain, slowing of bone damage progression, and prevention of hypercalcemia. This medication is often prescribed to cancer patients with bone damage. It minimizes the need for radiotherapy and mitigates the risk of broken bones. It improves patients’ chance of recovering bone strength and healing. This leads to an improved quality of life.


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Bisphosphonates are medication commonly prescribed to those suffering from osteoporosis or other bone diseases. Commonly reported side effects include stomach upset and heartburn but the risk of this can be mitigated by following all the instructions that come with your medication. Take your bisphosphonate on an empty stomach with a full eight-ounce glass of water first thing in the morning. Remain upright after taking this medication for at least 30 minutes and refrain from eating, drinking, or taking any other medications for 30 minutes, to two hours after taking this medicine, as it is very difficult for your body to absorb.

Make sure you are clear on what to do if you forget to take a dose. This medication may be taken as a quarterly shot or administered daily, weekly, or monthly as a tablet. Do not take more than two doses in a day or a monthly dose within seven days of your next scheduled dose. Your doctor will advise you on if you need to take calcium supplements, vitamin D supplements, or both alongside this medication. These supplements are taken daily regardless of the frequency you take your bisphosphonates.

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