Bisphosphonates: Warnings, Precautions, Side Effects, and Interactions
Wellness & SelfcareDrugs

What Are Bisphosphonates?

By
Updated on October 18, 2024
by

Bisphosphonates are prescription drugs that improve bone density. They’re used to treat several conditions associated with bone loss, including osteoporosis, and to reduce the risk of fractures. Bisphosphonates are generally safe and well tolerated, but side effects may occur.

Read on to learn more about bisphosphonates, including how they work, the conditions they treat, common side effects, and more

What Are Bisphosphonates?

Bisphosphonates are a group of drugs used to help prevent and treat bone loss. Doctors prescribe them for several different conditions.

 The following are some examples:

  • Osteopenia (softening of the bones)
  • Osteoporosis (reduced bone density and strength), including prevention and reducing the risk of fractures
  • Drug-related osteoporosis, for example caused by glucocorticoids or by some cancer treatments
  • Paget’s disease, a disorder that causes your bones to grow too large and weak
  • Cancers that have spread to the bone
  • Preventing cancers like breast cancer or myeloma from causing bone damage

Types of Bisphosphonates

Bisphosphonates are available by prescription. There are two main forms: drugs that you take orally (tablets or capsules that you take by mouth) and drugs that you take intravenously (through an IV injection or drip).

Oral bisphosphonates include:

  • Risedronate (Actonel or Altevia)
  • Alendronate (Fosamax)
  • Ibandronate (Boniva), which is also available intravenously
  • Zoledronic acid (Reclast or Zometa)
Intravenous bisphosphonates can be administered via infusions (IV drip) that last 20 minutes to an hour, or via intravenous injection.

 They include:

  • Pamidronate (Aredia)
  • Ibandronate
  • Zoledronic acid (Reclast/Zometa)

How Do Bisphosphonates Work?

Normally, your body breaks down bone tissue (through a process called bone resorption) to create new bone. But in some illnesses, the bone doesn’t get replaced fast enough, and more bone cells get damaged than renewed.

Bisphosphonates work by interfering with this process. They attach to binding sites on particular areas of the bone, specifically where the bone is being broken down and replaced.

 This slows down bone breakdown, reducing bone loss and making your bones stronger for longer.

What Are the Possible Side Effects of Bisphosphonates?

In general, bisphosphonates are safe and well tolerated, and any side effects are usually mild.

 The most common side effects of bisphosphonates are stomach irritation and heartburn, but these problems are often avoided by taking the medication as directed.

Other less common side effects include:

  • Bone or joint pain, or flu-like generalized pain
  • Other flu-like symptoms, such as muscle cramps or aches
  • Nausea, tummy pain or discomfort, constipation, or diarrhea
  • Headache or dizziness
  • Hypocalcemia (low levels of calcium in the blood)
  • Itchy rashes

In rare cases, the use of these drugs may cause:

  • Conditions that affect the eyes, such as uveitis, conjunctivitis, and scleritis
  • Osteonecrosis of the jaw, a condition that damages the bone cells in your jaw, causing gum and tooth problems

  • Atypical femur fractures (fractures in the thigh bone)

Are There Any Risks Related to Biphosphonates?

Bisphosphonates are not recommended if you:

  • Are allergic or hypersensitive to bisphosphonates
  • Have taken bisphosphonates in the past and developed osteonecrosis or had femur (thigh bone) fractures as a result
  • Have low levels of calcium in your bloodstream (hypocalcemia)
  • Have chronic kidney disease
  • Have had bariatric surgery
  • Have disorders of the food pipe (esophagus), including difficulty swallowing, narrowing of the esophagus, gastroesophageal reflux disease (GERD), or Barrett’s esophagus (a complication of GERD)
  • Can’t sit in an upright position for at least 30 minutes
To minimize the risk of side effects, you should always take bisphosphonates exactly as your doctor or pharmacist tells you.

Drug Interactions

Ask your doctor or pharmacist about bisphosphonates if you’re taking:

 
  • Calcium in any form, including calcium supplements, calcium gluconate, antacids like calcium citrate (Citrical) and calcium carbonate (Tums), or anything containing magnesium. These can block the bisphosphonates from being absorbed.

  • Diuretics or “water pills,” such as furosemide (Lasix) or ethacrynic acid (Edecrin)
  • Antibiotics like amphotericin B (Amphosin and Fungizone), amikacin, kanamycin, neomycin, paromomycin, streptomycin, tobramycin, and gentamicin. These may cause kidney dysfunction or lower calcium levels.
  • Aspirin and NSAIDs like ibuprofen and naproxen. These may compound the effects of bisphosphonates and damage your gastrointestinal tract.
  • Antiretroviral drugs (HIV treatment)

The Takeaway

Bisphosphonates are used to prevent bone loss and help improve bone density in conditions like osteoporosis. They’re generally safe and effective, but side effects are always possible. Bisphosphonates may interact with other drugs not listed in this article, so make sure you discuss any medications you’re taking with your doctor before you start taking them.

Resources We Trust

Meet Our Experts
See Our Editorial PolicyMeet Our Health Expert Network
Stephanie-Young-Moss-bio

Stephanie Young Moss, PharmD

Medical Reviewer

Stephanie Young Moss, PharmD, has worked in pharmacy, community outreach, regulatory compliance, managed care, and health economics and outcomes research. Dr. Young Moss is the owner of Integrative Pharmacy Outcomes and Consulting, which focuses on educating underserved communities on ways to reduce and prevent health disparities. She uses her platform to educate families on ways to decrease and eliminate health disparities by incorporating wellness and mental health techniques.

Young Moss is the creator of the websites DrStephanieYoMo.com and MenopauseInColor.com, providing practical health and wellness tips and resources for women experiencing perimenopause and menopause. She has over 100,000 people in her social media communities. She has also contributed to Pharmacy Times and shared her views on international and national podcasts and local television news.

She has served on various boards for organizations that focus on health equity, decreasing implicit bias, addressing social determinants of health, and empowering communities to advocate for their health. She has also been on the boards for the Minority Health Coalition of Marion County and Eskenazi Health Center, for which she was the clinical quality committee chair and board secretary and is currently the board treasurer. She is a board member for Community Action of Greater Indianapolis.

See full bio

Ana Sandoiu

Author

Ana is a freelance medical copywriter, editor, and health journalist with a decade of experience in content creation. She loves to dive deep into the research and emerge with engaging and informative content everyone can understand. Her strength is combining scientific rigor with empathy and sensitivity, using conscious, people-first language without compromising accuracy.

Previously, she worked as a news editor for Medical News Today and Healthline Media. Her work as a health journalist has reached millions of readers, and her in-depth reporting has been cited in multiple peer-reviewed journals. As a medical copywriter, Ana has worked with award-winning digital agencies to implement marketing strategies for high-profile stakeholders. She’s passionate about health equity journalism, having conceived, written, and edited features that expose health disparities related to race, gender, and other social determinants of health.

Outside of work, she loves dancing, taking analog photos, and binge-watching all the RuPaul’s Drag Race franchises.

See full bio
See Our Editorial PolicyMeet Our Health Expert Network
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Bisphosphonates. Cleveland Clinic. February 2023.
  2. Ganesan K et al. Bisphosphonate. StatPearls. July 2023.
  3. Bisphosphonates. Versus Arthritis.
  4. Bisphosphonate Therapy. American College of Rheumatology. February 2024.
  5. Bisphosphonates. Macmillan Cancer Support. February 2023.
  6. Bisphosphonates. Alzheimer’s Drug Discovery Foundation. December 2022.
  7. Rizzoli R et al. Adverse Reactions and Drug–Drug Interactions in the Management of Women With Postmenopausal Osteoporosis. Calcified Tissue International. June 2011.