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Osteoporosis: Should I Take Bisphosphonate Medicines?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Osteoporosis: Should I Take Bisphosphonate Medicines?
Get the facts
Your options
- Take bisphosphonate medicines to lower the risk of bone fractures.
- Don't take medicines. Try healthy habits to lower your risk.
Key points to remember
- If you have osteoporosis, bisphosphonate medicines can increase bone thickness and lower your risk of spine and hip fractures. You may also want to think about taking them if you have osteopenia or risk factors for osteoporosis. Some of the risk factors are smoking, getting little or no exercise, having a family history of osteoporosis, having certain medical conditions, and taking certain medicines. Talk with your doctor if you're not sure what your risk is.
- Bisphosphonates can have side effects, such as heartburn, belly pain, and headaches. These medicines have been in use for many years. But their long-term effects are not known.
- Whether you take medicine or not, healthy habits can also help protect your bones. Take calcium and vitamin D supplements. Get regular weight-bearing exercise, and cut back on alcohol. If you smoke, quit.
- If you start taking bisphosphonates and have problems with side effects, you can try other medicines. Talk with your doctor.
What is osteoporosis?
Osteoporosis is a disease that affects your bones. It means you have bones that are thin and brittle, with lots of holes inside them like a sponge. This makes them easy to break. It also increases your risk for spine and hip fractures. These fractures can be disabling and make it hard for you to live on your own.
Your bones naturally get thinner as you age, making them more likely to break. But whether you take medicine or not, healthy habits can protect your bones and prevent bone loss. Take calcium and vitamin D supplements. Get regular weight-bearing exercise, and cut back on alcohol. If you smoke, quit.
What are bisphosphonates?
Bisphosphonates are the most common medicines used to prevent bone loss in people who have osteoporosis. They slow the way bone dissolves and is absorbed by your body. They can increase bone thickness and strength.
They include:
- Alendronate (Fosamax).
- Ibandronate (Boniva).
- Risedronate (Actonel or Atelvia).
- Zoledronic acid (Reclast).
Bisphosphonates aren't right for everyone. Depending on your health, your doctor may suggest other medicines to help prevent bone loss. Your doctor may also suggest these other medicines if you are having a problem with side effects from bisphosphonates.
Other medicines include:
- Raloxifene (Evista).
- Calcitonin (Fortical or Miacalcin).
- Teriparatide (Forteo).
- Denosumab (Prolia).
- Hormone replacement therapy (HRT) or estrogen replacement therapy (ERT).
Women who have gone through menopause can take bisphosphonates instead of hormone replacement therapy for osteoporosis. But bisphosphonates won't help with menopause symptoms.
What are the benefits of these medicines?
Studies show that bisphosphonates increase bone thickness and lower the risk of fractures.1
How are they taken?
Most of these medicines should be taken in the morning with a full glass of water at least 30 minutes before eating a meal, drinking a beverage, or taking any other medicine. If your doctor prescribes the form of risedronate called Atelvia, take it right after breakfast with a glass of water.
Zoledronic acid is injected into a vein in your arm. Most people who use it get just one dose each year. One form of ibandronate is also given in a vein, usually every 3 months.
If you have osteoporosis, you should also take calcium and vitamin D supplements. Take them at least 2 hours before or after you take these medicines.
What are the side effects of these medicines?
If you take the medicines as prescribed, side effects are not common. But they can include:
- Heartburn, belly pain, irritation of the esophagus, and trouble swallowing if your bisphosphonates are taken by mouth. The esophagus is the tube that connects the throat to the stomach.
- Headache and pain in muscles and joints.
- Constipation, diarrhea, and passing gas.
- Allergic reactions.
If you start taking these medicines and have problems with side effects, you can try other medicines. Talk with your doctor.
Your doctor may want you to have a follow-up bone mineral density (BMD) test after you have been on treatment. If this is suggested for you, it will be done no more than every 2 years. Getting follow-up tests doesn't make your treatment work better.
Why might your doctor recommend these medicines?
Your doctor may suggest that you take bisphosphonates if:
- You have abnormal bone loss for your age.
- You have osteoporosis, osteopenia, or risk factors for osteoporosis.
- You have been taking hormone replacement therapy and stopped.
Compare your options
Compare
|
What is usually involved? |
|
|
|
What are the benefits? |
|
|
|
What are the risks and side effects? |
|
- You take bisphosphonate pills on a schedule that could be once a day, once a week, or once a month. Or you may get a shot in a vein in your arm once a year.
- You take calcium and vitamin D supplements.
- These medicines can help increase bone thickness and strength. This reduces your risk of hip and spine fractures.
- The long-term effects of these medicines are not known.
- Side effects are not
common but can include:
- Heartburn, belly pain, and irritation of the esophagus (the tube that connects the throat to the stomach).
- Headache and pain in muscles and joints.
- Constipation, diarrhea, and passing gas.
- Trouble swallowing.
- Allergic reactions.
- You take calcium and vitamin D supplements.
- You adopt healthy habits such as getting regular weight-bearing exercise, eating a healthy diet, limiting alcohol, and not smoking.
- You try other medicines such as:
- Raloxifene (Evista).
- Calcitonin (Calcimar or Miacalcin).
- Teriparatide (Forteo).
- Denosumab (Prolia).
- Hormone replacement therapy (HRT) or estrogen replacement therapy (ERT).
- You may be able to reduce your risk of fractures.
- You avoid the cost of medicine, unless you take another kind such as raloxifene.
- You avoid the side effects of these medicines.
- If your bones are very thin and brittle, you may be at risk for fractures.
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
Personal stories about taking bisphosphonate medications
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I was taking hormone therapy for osteoporosis but decided to quit after reading about the risks. I decided to try bisphosphonate medicines to protect against osteoporosis. I have small bones like my mother, and she suffered terribly in her old age from a collapsed spine.
Clarissa, age 60
I have terrible hot flashes. Taking hormones has saved my sanity. I guess I'll continue to take them for a few more years. In the meantime, my doctor tells me that I won't need to take other medicines to prevent osteoporosis.
Joy, age 49
I broke my hip when I fell in the bathroom. My doctor says I have osteoporosis and that I should take medicine to prevent more broken bones. I guess I better take it.
Jaime, age 71
I tried taking Fosamax (a bisphosphonate medicine) for osteoporosis, but it gives me terrible heartburn no matter how careful I am taking it. I'm going to ask my doctor for something else.
Brenda, age 65
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take bisphosphonate medicines
Reasons not to take bisphosphonates
I think this medicine is the best way for me to prevent bone fractures.
I think adopting healthy habits is the best way for me to prevent bone fractures.
I don't mind taking pills or getting shots if it means protecting my bones.
I don't like the idea of taking pills or getting shots.
I stopped taking hormones, and I'm worried about bone loss.
I haven't been taking hormones.
I'm not worried about the side effects of these medicines.
I am worried about the side effects of these medicines.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Taking bisphosphonates
NOT taking bisphosphonates
What else do you need to make your decision?
Check the facts
Can bisphosphonate medicines help prevent bone fractures?
- YesYou're right. Bisphosphonates increase bone thickness and strength and can lower your risk of spine and hip fractures.
- NoSorry, that's not right. Bisphosphonates increase bone thickness and strength and can lower your risk of spine and hip fractures.
- I'm not sureIt may help to go back and read "Get the Facts." Bisphosphonates increase bone thickness and strength and can lower your risk of spine and hip fractures.
Can healthy habits also help protect your bones?
- YesYou're right. Whether you take medicine or not, healthy habits can also help protect your bones. Try taking calcium and vitamin D supplements. Get regular weight-bearing exercise, cut back on alcohol, and quit smoking.
- NoSorry, that's not right. Whether you take medicine or not, healthy habits can also help protect your bones. Try taking calcium and vitamin D supplements. Get regular weight-bearing exercise, cut back on alcohol, and quit smoking.
- I'm not sureIt may help to go back and read "Get the Facts." Whether you take medicine or not, healthy habits can also help protect your bones.
Are bisphosphonates the only medicines you can take for osteoporosis?
- YesSorry, that's not right. Talk with your doctor about other medicines you might try besides bisphosphonates, especially if you have problems with side effects.
- NoYou're right. Talk with your doctor about other medicines you might try besides bisphosphonates, especially if you have problems with side effects.
- I'm not sureIt may help to go back and read "Get the Facts." You can talk with your doctor about other medicines you might try besides bisphosphonates, especially if you have problems with side effects.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
Certainty
How sure do you feel right now about your decision?
Check what you need to do before you make this decision.
Use the following space to list questions, concerns, and next steps.
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Your decision
Next steps
Which way you're leaning
How sure you are
Your comments
Your knowledge of the facts
Key concepts that you understood
Key concepts that may need review
Getting ready to act
Patient choices
Osteoporosis: Should I Take Bisphosphonate Medicines?
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the facts
Your options
- Take bisphosphonate medicines to lower the risk of bone fractures.
- Don't take medicines. Try healthy habits to lower your risk.
Key points to remember
- If you have osteoporosis, bisphosphonate medicines can increase bone thickness and lower your risk of spine and hip fractures. You may also want to think about taking them if you have osteopenia or risk factors for osteoporosis. Some of the risk factors are smoking, getting little or no exercise, having a family history of osteoporosis, having certain medical conditions, and taking certain medicines. Talk with your doctor if you're not sure what your risk is.
- Bisphosphonates can have side effects, such as heartburn, belly pain, and headaches. These medicines have been in use for many years. But their long-term effects are not known.
- Whether you take medicine or not, healthy habits can also help protect your bones. Take calcium and vitamin D supplements. Get regular weight-bearing exercise, and cut back on alcohol. If you smoke, quit.
- If you start taking bisphosphonates and have problems with side effects, you can try other medicines. Talk with your doctor.
What is osteoporosis?
Osteoporosis is a disease that affects your bones. It means you have bones that are thin and brittle, with lots of holes inside them like a sponge. This makes them easy to break. It also increases your risk for spine and hip fractures. These fractures can be disabling and make it hard for you to live on your own.
Your bones naturally get thinner as you age, making them more likely to break. But whether you take medicine or not, healthy habits can protect your bones and prevent bone loss. Take calcium and vitamin D supplements. Get regular weight-bearing exercise, and cut back on alcohol. If you smoke, quit.
What are bisphosphonates?
Bisphosphonates are the most common medicines used to prevent bone loss in people who have osteoporosis. They slow the way bone dissolves and is absorbed by your body. They can increase bone thickness and strength.
They include:
- Alendronate (Fosamax).
- Ibandronate (Boniva).
- Risedronate (Actonel or Atelvia).
- Zoledronic acid (Reclast).
Bisphosphonates aren't right for everyone. Depending on your health, your doctor may suggest other medicines to help prevent bone loss. Your doctor may also suggest these other medicines if you are having a problem with side effects from bisphosphonates.
Other medicines include:
- Raloxifene (Evista).
- Calcitonin (Fortical or Miacalcin).
- Teriparatide (Forteo).
- Denosumab (Prolia).
- Hormone replacement therapy (HRT) or estrogen replacement therapy (ERT).
Women who have gone through menopause can take bisphosphonates instead of hormone replacement therapy for osteoporosis. But bisphosphonates won't help with menopause symptoms.
What are the benefits of these medicines?
Studies show that bisphosphonates increase bone thickness and lower the risk of fractures.1
How are they taken?
Most of these medicines should be taken in the morning with a full glass of water at least 30 minutes before eating a meal, drinking a beverage, or taking any other medicine. If your doctor prescribes the form of risedronate called Atelvia, take it right after breakfast with a glass of water.
Zoledronic acid is injected into a vein in your arm. Most people who use it get just one dose each year. One form of ibandronate is also given in a vein, usually every 3 months.
If you have osteoporosis, you should also take calcium and vitamin D supplements. Take them at least 2 hours before or after you take these medicines.
What are the side effects of these medicines?
If you take the medicines as prescribed, side effects are not common. But they can include:
- Heartburn, belly pain, irritation of the esophagus, and trouble swallowing if your bisphosphonates are taken by mouth. The esophagus is the tube that connects the throat to the stomach.
- Headache and pain in muscles and joints.
- Constipation, diarrhea, and passing gas.
- Allergic reactions.
If you start taking these medicines and have problems with side effects, you can try other medicines. Talk with your doctor.
Your doctor may want you to have a follow-up bone mineral density (BMD) test after you have been on treatment. If this is suggested for you, it will be done no more than every 2 years. Getting follow-up tests doesn't make your treatment work better.
Why might your doctor recommend these medicines?
Your doctor may suggest that you take bisphosphonates if:
- You have abnormal bone loss for your age.
- You have osteoporosis, osteopenia, or risk factors for osteoporosis.
- You have been taking hormone replacement therapy and stopped.
2. Compare your options
| Take bisphosphonates | Don't take bisphosphonates | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
Personal stories about taking bisphosphonate medications
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I was taking hormone therapy for osteoporosis but decided to quit after reading about the risks. I decided to try bisphosphonate medicines to protect against osteoporosis. I have small bones like my mother, and she suffered terribly in her old age from a collapsed spine."
— Clarissa, age 60
"I have terrible hot flashes. Taking hormones has saved my sanity. I guess I'll continue to take them for a few more years. In the meantime, my doctor tells me that I won't need to take other medicines to prevent osteoporosis."
— Joy, age 49
"I broke my hip when I fell in the bathroom. My doctor says I have osteoporosis and that I should take medicine to prevent more broken bones. I guess I better take it."
— Jaime, age 71
"I tried taking Fosamax (a bisphosphonate medicine) for osteoporosis, but it gives me terrible heartburn no matter how careful I am taking it. I'm going to ask my doctor for something else."
— Brenda, age 65
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take bisphosphonate medicines
Reasons not to take bisphosphonates
I think this medicine is the best way for me to prevent bone fractures.
I think adopting healthy habits is the best way for me to prevent bone fractures.
I don't mind taking pills or getting shots if it means protecting my bones.
I don't like the idea of taking pills or getting shots.
I stopped taking hormones, and I'm worried about bone loss.
I haven't been taking hormones.
I'm not worried about the side effects of these medicines.
I am worried about the side effects of these medicines.
My other important reasons:
My other important reasons:
4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Taking bisphosphonates
NOT taking bisphosphonates
5. What else do you need to make your decision?
Check the facts
1. Can bisphosphonate medicines help prevent bone fractures?
- Yes
- No
- I'm not sure
2. Can healthy habits also help protect your bones?
- Yes
- No
- I'm not sure
3. Are bisphosphonates the only medicines you can take for osteoporosis?
- Yes
- No
- I'm not sure
Decide what's next
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
Certainty
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
- I'm ready to take action.
- I want to discuss the options with others.
- I want to learn more about my options.
3. Use the following space to list questions, concerns, and next steps.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
Last Revised: November 17, 2010
Author: Healthwise Staff
Medical Review: Anne C. Poinier, MD - Internal Medicine & Carla J. Herman, MD, MPH - Geriatric Medicine
This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
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