Should I take bisphosphonate medications for osteoporosis?
Introduction
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
Bisphosphonate medications, such as risedronate (Actonel), etidronate (Didronel), or alendronate (Fosamax), are the most commonly prescribed medications for osteoporosis. An intravenous bisphosphonate called zoledronic acid (Aclasta) is also available. However, bisphosphonate medications may not be right for you. See the Medications section of the topic Osteoporosis if you are considering taking other medications.
Bisphosphonate medications increase bone density and decrease your risk of spine and hip fractures. However, they have some side effects, and their long-term risks have not been studied. Consider the following when making your decision:
- You may want to take a bisphosphonate to prevent fractures if you have been diagnosed with osteoporosis.
- You may want to take a bisphosphonate if you have osteopenia and have a strong risk factor, such as long-term corticosteroid use, a history of smoking, or other risk factors.
- If you have osteopenia but no other risk factors for osteoporosis, you may want to try healthy habits, including taking recommended amounts of calcium and vitamin D, getting regular exercise, limiting alcohol use, and abstaining from smoking.
- You may want to take a bisphosphonate for osteoporosis instead of hormone replacement therapy (HRT), if you are concerned about the health risks of taking HRT.
- If you quit HRT, you may want to take a bisphosphonate to protect against the rapid bone loss that may develop after quitting HRT.
- Your doctor may initially recommend a bisphosphonate for osteoporosis after considering your age, other existing health conditions, or other factors.
- If you start bisphosphonates and experience bothersome side effects, other medications for osteoporosis are available.
Medical Information
What is osteoporosis?
Osteoporosis is a progressive disease that causes your bones to become thin and brittle, significantly increasing your risk for fractures of the vertebrae and hip. These fractures may require hospitalization, can cause loss of height and severe back pain, and may lead to permanent disability.
What are bisphosphonate medications?
Bisphosphonates, such as risedronate (Actonel), etidronate (Didronel), or alendronate (Fosamax), slow the rate at which bone dissolves and is absorbed into the body, resulting in increased bone density and strength.
Studies show that bisphosphonates decrease the risk of fractures, including fractures of the vertebrae and the hip, by as much as 50%.1 And one study showed a 70% decrease in vertebral fractures in people taking zoledronic acid.2
Bisphosphonates are the most commonly prescribed medications for osteoporosis. However, bisphosphonate medications may not be right for you. Depending upon your medical history and current condition, your health professional may recommend other osteoporosis medications, such as:
- Raloxifene (Evista).
- Calcitonin (Calcimar or Miacalcin).
- Teriparatide (Forteo).
- Hormone replacement therapy (HRT) or estrogen replacement therapy (ERT).
While bisphosphonates can be taken instead of hormone replacement therapy for osteoporosis in post-menopausal women, bisphosphonates will not help hot flashes or other symptoms of menopause.
How are bisphosphonates taken?
Bisphosphonates are taken by mouth on a daily, weekly, or monthly basis. You should take this medication with a full glass of water in the morning on an empty stomach. Stay upright and wait 30 minutes before eating or drinking anything or taking another medication.1
Zoledronic acid is given intravenously. Most people using zoledronic acid are given just one intravenous infusion each year.
If you are taking medications for osteoporosis, you should also be taking calcium and vitamin D supplements. You should take calcium and vitamin D at least 2 hours before or after taking bisphosphonates.
What are the side effects of taking bisphosphonate medications?
If the medication is taken as directed, side effects are uncommon, but they may include heartburn, abdominal pain and irritation of the esophagus, headache, pain in your muscles and joints, constipation, diarrhea, difficulty swallowing, and increased gas. It may take several months for heartburn to appear. Allergic reactions are rare.
Serious problems with bone healing, particularly after dental surgery, have been found in some people taking bisphosphonates.3 Talk with your doctor if you are taking bisphosphonates or are about to start taking them, and you need dental surgery.
Zoledronic acid has been associated with an irregular heartbeat called atrial fibrillation.2
Because these are relatively new medications, their long-term effectiveness has not been studied. Some experts recommend that you have a bone mineral density (BMD) test after taking bisphosphonates for 4 years. If your BMD is still low, they suggest continuing treatment for another 3 years.1 But getting regular bone mineral density tests will not make bisphosphonates work better.4
Bisphosphonates should not be taken by people with severe kidney problems, heartburn, or esophagitis. Bisphosphonates should not be taken with teriparatide, as neither medication is as effective when taken together. However, bisphosphonates may be taken together with HRT, because the effect of these two medications taken together is more than either alone.
If you need more information, see the topic Osteoporosis.
Your Information
Your choices are:
- Take bisphosphonate medications as well as calcium and vitamin D supplements. Calcium and vitamin D should be taken at least 2 hours before or after taking bisphosphonates.
- Take other osteoporosis medications, such as raloxifene (Evista), calcitonin (Calcimar or Miacalcin), teriparatide (Forteo), and hormone replacement therapy (HRT), as well as calcium and vitamin D supplements.
- Try healthy habits, including taking recommended amounts of calcium and vitamin D, getting regular exercise, limiting alcohol use, and abstaining from smoking.
The decision about whether to take bisphosphonate medications takes into account your personal feelings and the medical facts.
Deciding about bisphosphonate medications Reasons to take bisphosphonate medications Reasons not to take bisphosphonate medications
- In general, bisphosphonates decrease the risk of fractures of the vertebrae, the hip, and of other bones by as much as 50% in people with osteoporosis.1 And one study showed a 70% decrease in vertebral fractures in people taking zoledronic acid.2
- Bisphosphonates can protect against rapid bone loss after quitting HRT.5
- Bisphosphonate pills can be taken once a week and have few side effects if taken as directed.
- Zoledronic acid can be taken as a once-a-year intravenous dose.
Are there other reasons you might want to take bisphosphonate medications?
- Long-term effects are not known.
- You already have a problem with heartburn or abdominal pain, which may be made worse by oral bisphosphonates.
- You have severe kidney problems, heartburn, or esophagitis.
- It would be difficult for you to take this medication as directed.
- You are at high risk for breast cancer. You may want to talk with your doctor about taking raloxifene instead of a bisphosphonate to lower your cancer risk.
- You are planning to have dental surgery.
Are there other reasons you might not want to take bisphosphonate medications?
These personal stories may help you make your decision.
Wise Health Decision
Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about taking bisphosphonate medications. Discuss the worksheet with your health professional.
Circle the answer that best applies to you.
My health professional says I have abnormal bone loss for my age. Yes No Unsure My health professional says I should quit taking hormones, but I'm concerned about osteoporosis. Yes No Unsure I have severe hot flashes, so I need to take hormones anyway. Yes No NA* I have broken a bone in the past 5 years. Yes No NA My health professional says I have normal bone loss for my age. Yes No Unsure I have taken corticosteroids for many years. Yes No NA I am taking calcium supplements and have big bones. I'm not concerned about osteoporosis. Yes No NA *NA=Not applicable
Use the following space to list any other important concerns you have about this decision.
What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use bisphosphonate medications.
Check the box below that represents your overall impression about your decision.
Leaning toward taking bisphosphonate medications
Leaning toward NOT taking bisphosphonate medications
Return to the topic Osteoporosis.
| Author: | Douglas Dana Robin Parks, MS | Last Updated: February 21, 2007 |
| Medical Review: | Joy Melnikow, MD, MPH - Family Medicine Carla J. Herman, MD, MPH - Internal Medicine Andrew Swan, MD, CCFP, FCFP - Family Medicine | |
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