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.
Bisphosphonates can have side effects, such as heartburn, belly pain, and headaches. These medicines have been in use for about 10 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.

FAQs

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:

Risedronate (Actonel).
Ibandronate (Boniva).
Alendronate (Fosamax).
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 (Calcimar or Miacalcin).
Teriparatide (Forteo).
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 alendronate and risedronate lower the risk of spine fractures by 50%. ¹ This means that your risk for fractures is half as high as it would be for a woman with osteoporosis who does not take these medicines.

Zoledronic acid is another type of bisphosphonate. It also lowers the risk of bone fractures in women who have gone through menopause and have osteoporosis.²

How are they taken?

You take bisphosphonate pills on a schedule that could be once a day, once a week, or once a month. You take them with a full glass of water in the morning on an empty stomach. Stay upright. Wait 30 minutes before you eat or drink anything or take another medicine.

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.

Most experts suggest that you have a bone mineral density (BMD) test after taking these medicines for 2 years.³

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. These medicines can protect against rapid bone loss after you quit HRT.⁴

2. Compare Options

	Take bisphosphonates	Don't take bisphosphonates
What is usually involved?	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.	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), hormone replacement therapy (HRT), or estrogen replacement therapy (ERT).
What are the benefits?	These medicines can help increase bone thickness and strength. This reduces your risk of hip and spine fractures.	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.
What are the risks and side effects?	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. Headache and pain in muscles and joints. Constipation, diarrhea, and passing gas. Trouble swallowing. Allergic reactions.	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.

For more information, see the topic Osteoporosis.

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 medications 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 medications 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 medication to prevent more broken bones. I guess I better take it. "

— Jaime, age 71

"I tried taking Fosamax (a bisphosphonate medication) 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. Your Feelings

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.

More important

Equally important

More important

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.

More important

Equally important

More important

I stopped taking hormones, and I'm worried about bone loss.

I haven't been taking hormones.

More important

Equally important

More important

I'm not worried about the side effects of these medicines.

I am worried about the side effects of these medicines.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Your Decision

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

Leaning toward

Undecided

Leaning toward

5. Quiz Yourself

Check the facts.

1. Can bisphosphonate medicines help prevent bone fractures?

Yes
No
I'm not sure

You're right. Bisphosphonates increase bone thickness and strength and can lower your risk of spine and hip fractures.

2. Can healthy habits also help protect your bones?

Yes
No
I'm not sure

You'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.

3. Are bisphosphonates the only medicines you can take for osteoporosis?

Yes
No
I'm not sure

You're right. Talk with your doctor about other medicines you might try besides bisphosphonates, especially if you have problems with side effects.

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?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

Nothing. 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.

References

Citations

Hochberg MC (2002). Bisphosphonates. In SR Cummings et al., eds., Osteoporosis: An Evidence-Based Guide to Prevention and Management, pp. 181–195. Philadelphia: American College of Physicians–American Society of Internal Medicine.
Black DM, et al. (2007). Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. New England Journal of Medicine, 356(18): 1809–1822.
National Osteoporosis Foundation (2008). Clinician's Guide to Prevention and Treatment of Osteoporosis. Available online: http://www.nof.org/professionals/Clinicians_Guide.htm.
Cosman F, et al. (2002). Selection of medications and guidelines for fracture prevention. In SR Cummings et al., eds., Osteoporosis: An Evidence-Based Guide to Prevention and Management, pp. 273–281. Philadelphia: American College of Physicians–American Society of Internal Medicine.