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Bisphosphonates

Bisphosphonates are non-hormonal medications that are prescribed to help prevent bone density loss that leads to osteoporosis. 

  1. Prevents osteoporosis from getting worse.
  2. Available as a tablet or administered as an injection.
  3. Tablets should be taken on an empty stomach. 

If you have any concerns related to osteoporosis and its treatment, you can speak with one of our GMC-registered clinicians via our online video consultation service. They are available for appointments between 9.30am-4.30pm, Monday to Friday. 

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Product information

What are bisphosphonates? 

Bisphosphonates are medications that are prescribed and administered in order to prevent bone density from deteriorating (osteoporosis). They are available in various forms and can be taken orally in tablet form or given via an injection.

What is osteoporosis?

Osteoporosis is the weakening of bones that leads to them becoming increasingly fragile, which can result in breaks and fractures during knocks and falls. The most common injuries experienced with the condition are broken wrists, hips and the bones of the spine. Other injuries are possible, however, and fractured ribs as a result of sneezing or coughing, as well as the bones of the spine collapsing, are also prevalent. 

The condition itself does not cause any pain, but fractures and breaks can result in long-term discomfort, particularly in cases that are related to the spine. There is also a possibility that you will develop a stoop if you’re elderly as a consequence of the bones in the spine weakening. 

Before osteoporosis occurs, a condition called osteopenia may be diagnosed, where scans show a bone density that is lower than average for your age. Osteopenia does not necessarily lead to osteoporosis, but treating it with bisphosphonates can prevent it from progressing to osteoporosis.

How common is osteoporosis?

Osteoporosis is a fairly common condition in the UK, with around 3 million people thought to experience it. Loss of bone density is a normal part of ageing, but for some this process can be accelerated at an early age. Women are more at risk of the condition than men, largely due to the changes in hormones during the menopause, which usually begins in the mid-40’s, but that is not to say that it cannot affect men and younger women. Having undergone a hysterectomy or having not a period for over six months will also increase the risks of it developing. 

It is not always understood why osteoporosis occurs in men, but alcohol misuse, hypogonadism and certain medications are the most common causes.

What other factors cause osteoporosis? 

Other triggers for osteoporosis include medications (such as long term use of steroids, anti-inflammatories or hormonal treatments), an overactive thyroid, Cushing’s syndrome, issues with the pituitary gland, a family history of the condition, being underweight, eating disorders, smoking, consuming too much alcohol, rheumatoid arthritis, malabsorption problems (usually related to Crohn’s or coeliac disease) and being bed-bound for prolonged periods of time. 

Early diagnosis of osteoporosis is key to preventing the condition from worsening and requires a bone density scan, which is done through the use of a low dose X-ray. Once the diagnosis has been made, the treatment will be informed by a number of factors, taking into account your age, sex, history of injuries and future risk of broken bones.

How is osteoporosis treated? 

Medications may not always be necessary, or you may want to avoid them, but dietary changes can be beneficial, such as adding more vitamin D and calcium rich foods to your diet. Most vitamin D is absorbed from sunlight however, so it’s likely you will need to take a supplement to ensure you are getting enough during the autumn and winter months.

Bisphosphonates slow the rate at which bone density is lost, and take approximately six months to have an effect. It is likely you will have to take them for up to five years. Selective oestrogen receptor modulators (SERMs) affect bone density in the same way as the hormone oestrogen, and as such are particularly effective at preventing issues with the bones of the spine. 

Parathyroid hormones are produced naturally by the body, but when they become too low they can be increased with parathyroid treatment, which is the only action that can increase bone density as opposed to preventing its loss. However, due to the risks of side effects, it is only used in a minority of cases. 

Hormone replacement therapy (HRT) is a common treatment for the menopause; although it is rarely used as a treatment for osteoporosis, it can help reduce the rate at which bone density falls. For cases in men where low testosterone is the cause of osteoporosis, testosterone treatment can be effective. 

Can osteoporosis be prevented? 

The best ways to restrict the likelihood of osteoporosis from developing in the first place are to take at least two and a half hours of aerobic exercise per week and to incorporate foods that are nutritious and calcium rich into your diet. Ensuring that you get exposure to sunlight is also important, although this can be difficult during the winter period. Vitamin D supplements may be used to help with this. 

If you would like to speak to a GPhC-registered clinician about bisphosphonates or any related conditions, our online video consultation service is available from 9.30am-4.30pm, five days a week. Our clinicians can also issue referral to specialists for treatment and fit notes, where appropriate.  

Page last reviewed:  01/07/2020
Side effects and warnings

What side effects can bisphosphonates cause? 

Side effects are a risk with any medication. Because there are different types of bisphosphonates, you should speak with your prescribing clinician or refer to the patient information leaflet that comes with your medication to establish what the risks of side effects are for your specific treatment. 

The following information relates to the bisphosphonate alendronic acid. You should seek 

immediate medical attention if you experience allergic reactions, problems with your gullet, such as narrowing or difficulty swallowing, or are unable to stand or sit upright for at least 30 minutes.

Other side effects include: 

Very common: bone pain, muscle pain and joint pain. 

Common: heartburn, difficulty swallowing, ulceration of the gullet, chest pain, swelling of the joints, abdominal pain, discomfort in the stomach, belching after eating, constipation, bloating, diarrhoea, flatulence, hair loss, itching, headaches, dizziness, tiredness and swelling in the hands or legs.

Uncommon: nausea, vomiting, inflammation of the gullet or stomach, tar-like stools, blurred vision, pain or redness in the eye, rashes, flu-like symptoms, such as aching muscles and taste disturbances. 

Rare: allergic reactions, low blood calcium levels, muscle cramps, spasms, tingling sensation in the fingers and mouth, stomach or peptic ulcers, narrowing of the gullet, rash made worse by sunlight, pain in the mouth, pain in the jaw, swelling or soreness of the mouth, numbness in the jaw and loose teeth.

Very rare: ear pain, discharge from the ear, ear infection. Should you experience any of these symptoms, you should talk to your doctor immediately as it may be an indication of damage to the bones of the ear.

Is it safe to take bisphosphonates alongside other treatments?

It’s important that you inform your prescribing clinician of any treatments you are currently taking or have taken recently. Bisphosphonate may differ in terms of what medications they interact with, so it is important that you refer to the patient information leaflet that comes with your specific medication or discuss this with your doctor before starting treatment. The following information relates to alendronic acid. 

Because many osteoporosis treatments are taken alongside calcium and vitamin supplements, it is important to note that their interaction may weaken the effects of the treatment. You should therefore follow the instructions given to you by your prescribing doctor relating to how and when to take each tablet. Non-steroidal anti-inflammatory drugs (NSAIDs) which include aspirin, may increase the risk of digestive and stomach issues. 

Warnings and precautions when using bisphosphonates 

If you have any health conditions, you should inform your prescribing clinician as they will need to determine which treatments are suitable for you. 

In the case of alendronic acid, it’s particularly important that you speak to your doctor if you experience any of the following: kidney problems, digestive problems, issues swallowing, low blood calcium, poor dental health, gum disease, a future dental extraction, cancer, are undergoing chemotherapy or radiotherapy, are taking corticosteroids or if you smoke.

Is it safe to take bisphosphonates if you are pregnant?

Because each bisphosphonate is different, you should ask your doctor about what the risks are in terms of your specific medication before starting the treatment course. If you are pregnant, thinking of becoming pregnant or think you might be pregnant, you should first speak with your prescribing clinician. You should not take bisphosphonates and breastfeed.

What types of bisphosphonates are available? 

There are a number of different types of bisphosphonates available, including alendronic acid, zoledronic acid, risedronic acid and ibandronic acid.

Page last reviewed:  01/07/2020
Questions and Answers

Can bisphosphonates affect my ability to drive?

Some reported side effects of bisphosphonates include dizziness and visual issues, so it is important to understand exactly how this treatment affects you before operating any form of heavy machinery.

Are there any special dietary requirements when taking bisphosphonates?

All food and drinks, including water, can make bisphosphonates less effective, so it is important to follow the patient information leaflet provided with your medication in full.

Can I buy bisphosphonates over the counter? 

No. Bisphosphonates are a prescription-only treatment. 

How can I buy bisphosphonates online?

You can book an appointment with one of our registered clinicians using our online video consultation service. They are available from 9.30am-4.30pm, Monday to Friday. Our clinicians can also provide fit notes and referral to specialists for treatment, where suitable.  

 

Page last reviewed:  01/07/2020

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