Drug Class Guide
Bisphosphonates
The most widely used osteoporosis medicines, proven to lower the risk of hip and spine fractures.
How Bisphosphonates Work
Bone is constantly broken down and rebuilt. Bisphosphonates attach to bone and slow the osteoclasts that break it down, so bone density holds steady or improves and fractures become less likely. Because they stay in bone for years, their effect lasts after you stop.
What Bisphosphonates Treat
- Osteoporosis
- Bone loss from long-term steroid use
- Paget disease of bone
Bisphosphonates in Our Medication Guide
Common Side Effects
The pills can irritate the esophagus and cause heartburn if not taken correctly. The first infusion of zoledronic acid often causes a day or two of flu-like aches and fever. Bone, joint or muscle pain occasionally occurs.
Important Cautions
- Take the pills first thing in the morning with a full glass of plain water, and stay upright and avoid food for at least 30 minutes (60 for ibandronate).
- Kidney function is checked first; they are not used when kidney function is very low.
- Rare risks with long-term use include jaw bone damage (osteonecrosis) and unusual thigh-bone fractures. Report new thigh or groin pain.
Common Questions About Bisphosphonates
How long should I take a bisphosphonate?
Many people are reassessed after about five years of pills or three years of yearly infusions. If fracture risk has dropped, a "drug holiday" may be possible, because the medicine keeps working for a while after it is stopped. People at very high risk often continue longer.
Do I need to worry about my jaw with dental work?
Jaw osteonecrosis is rare in people taking bisphosphonates for osteoporosis. Keeping up with dental care lowers the risk further. Tell your dentist you take one, especially before an extraction or implant; most routine dental work can go ahead.
How is Prolia different from a bisphosphonate?
Denosumab (Prolia) is an injection every six months that blocks a signal osteoclasts need, rather than binding to bone. It works well, but its effect wears off quickly: stopping it without a follow-up medicine can cause rapid bone loss and spine fractures.
This guide is general information, not a substitute for advice about your own medicines. Do not start, stop or switch a medication without talking with your doctor. Questions about a prescription? Our internal medicine team can help.
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Trusted Resources for Bisphosphonates
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