Bisphosphonates: Uses, Precautions, Side Effects & More

Bisphosphonates are drugs commonly used to treat and prevent bone-density issues like osteoporosis. According to the Centers for Disease Control and Prevention, about 10 million Americans have osteoporosis. That’s an alarming number considering that this disease is almost always preventable, treatable and even reversible with the right care.

Fortunately, thanks to advances in drug discovery, people living with osteoporosis now have access to a variety of safe and effective drugs that can help manage their condition.

Without question, Bisphosphonates are one of the most impactful medications available today. As the name suggests, these drugs contain two phosphate groups: One on the nitrogen atom and another on the third carbon atom. There are several different types of Bisphosphonates — Let’s take a closer look at each one:

How do Bisphosphonates Work?

Bisphosphonates work, in part, by altering the rate of bone turnover. That is, they affect the process by which old bone is broken down and replaced with new bone. Studies show that the breakdown of old bone is a two-step process. First, the body triggers the breakdown of old bone via resorption. Resorption is a healthy process that allows the body to recycle old bone into new bone. 5% of the Skeleton is replaced each year.

Why? To replace the old and damaged bone with fresh and healthy bone. While the process of resorption is normal and healthy, it can be problematic when it happens too quickly. When the rate of resorption accelerates, the amount of new bone created each year can’t keep up. As a result, there’s less healthy bone available to support the body. That’s why resorption is often the first sign of a bone-density issue—and it’s also why Bisphosphonates are so effective.

Side Effects of Bisphosphonates

Several side effects can occur from taking Bisphosphonates, some of which are mild and others quite severe. Fortunately, most people won’t experience all of these side effects, and most side effects will go away once you stop taking the drug. If you experience any side effects while taking Bisphosphonates, talk with your doctor about how to manage them. Some common side effects to look out for include: 

  • Nausea 
  • Diarrhea 
  • Constipation 
  • Changes in taste 
  • Headaches 
  • Joint pain 
  • Muscle pain 
  • Swelling 
  • Trouble sleeping 
  • Urinary tract infections 
  • Decreased bone strength 
  • Decreased bone density 
  • Decreased muscle mass 
  • Decreased sex drive 
  • Dry mouth 
  • Dry or discolored skin 
  • Hair loss or thinning hair 
  • Increased risk of fractures 
  • Kidney stones 
  • Mood changes 
  • Reduced ability to fight infections 
  • Unusual or abnormal dreams 
  • Visual disturbances
Warnings and Precautions
There are some important things to remember if you’re taking Bisphosphonates. First and foremost, this drug is generally only recommended for people who have already begun to experience bone-density issues. If you’re otherwise healthy, it’s best to start taking Bisphosphonates as a preventive measure. In addition, while Bisphosphonates are a safe and effective drug, you should be aware of certain risks.

For example, it’s possible that these drugs could reduce the ability of your bones to heal after a fracture. And as mentioned above, Bisphosphonates could reduce your ability to fight infections. In addition, it’s possible that long-term use of Bisphosphonates could cause you to lose muscle mass. And some research suggests that long-term use of Bisphosphonates could increase your risk of developing osteonecrosis.

Drug Interactions

It’s important to note that certain medications could increase your risk of experiencing side effects while taking Bisphosphonates. As with any drug, it’s possible that Bisphosphonates could interact with other medications. Some drugs that could increase your risk of a bad interaction with Bisphosphonates include 

  • Cyclosporine 
  • Ketorolac 
  • NSAIDs 
  • Paclitaxel 
  • Celecoxib 
  • Everolimus
  • Rifampin
  • St. John’s Wort.

Conclusion: Uses of Bisphosphonates

Bisphosphonates are an important class of drugs used to treat and prevent bone-density issues like osteoporosis. These drugs work, in part, by affecting the rate at which old bone is broken down and replaced with new bone. While there are several different types of bisphosphonates, all of these drugs have similar benefits and risks. Each class also has a unique set of advantages and disadvantages.

In addition, the dosages and how frequently you take each drug will vary. Now that you know what Bisphosphonates are and how they work, it’s time to find the one that’s right for you. Bisphosphonates may be a solution if you’re experiencing bone-density issues but are not ready for more invasive treatment options.


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