Bisphosphonates are a group of drugs that work by slowing bone loss. They reduce the risk of hip and spine fractures. Bone renewal is a slow process, but in many people an increase in bone density can be measured over five years of treatment.
Bisphosphonates can be used to reduce the risk of hip and spine fractures in osteoporosis. They may also be used, at different doses, to treat Paget's disease of bone.
Bisphosphonates can be taken by mouth (orally), through a drip (intravenous infusion) or by injection.
It's important to continue treatment as your doctor advises – even though you won't be able to feel whether it's working.
Because longer-term treatment can sometimes have side-effects your doctor may suggest a break from treatment after 3–5 years. The benefits of treatment last a long time though, so there's no need to worry that these will be lost if your doctor does suggest a 'treatment holiday'.
There are several different bisphosphonates, and how they can be taken varies. The three ways in which they can be taken (administered) are:
Oral bisphosphonates tend to be poorly absorbed by the body and can cause irritation of the gullet (heartburn), so it's very important that you carefully follow the instructions for taking your medication:
If you can't tolerate bisphosphonates by mouth it's possible to have them through a drip into a vein (intravenous infusion) or as an injection:
Bisphosphonates are generally well tolerated. The risk of digestive problems with oral preparations is very much reduced if you carefully follow the instructions that come with your medicine.
Less common side-effects include:
You should report any side-effects to your doctor or rheumatology nurse and the drug may be stopped if necessary.
There are three very rare side-effects:
Your doctor will review your treatment from time to time to make sure the benefits of the treatment still outweigh the risks. Most specialists limit treatment with oral bisphosphonates to five years (or three years for intravenous zoledronate) to minimise the risks of rare, long-term side-effects. However, some people will need more lengthy treatment.
It's usually fine to take other medicines alongside bisphosphonates, but check with your doctor or pharmacist before starting any new medications.
There's no reason why you shouldn't have vaccinations while you're on bisphosphonates.
Alcohol is unlikely to interact with bisphosphonates. However, heavy drinking is a risk factor for osteoporosis and for having falls so it's recommended that you drink alcohol only in moderation.
Osteoporosis usually affects older people, so there's only limited evidence concerning the use of bisphosphonates by women who are pregnant or breastfeeding.
Bisphosphonates can cross the placenta to the unborn baby and can also pass into breast milk in small amounts. There's no clear evidence that this is harmful to the child. However, as a precaution, it's recommended that treatment with bisphosphonates is stopped at least three months before trying for a baby and while breastfeeding.
It's important to get enough calcium and vitamin D as a lack of these can lessen the effect of bisphosphonates. You may be prescribed a daily supplement of calcium and/or vitamin D.
During bisphosphonate therapy you should maintain good oral hygiene and have regular dental check-ups. If you're expecting to have dental work it's usually best if this can be completed before starting bisphosphonates. However, it may not be necessary to stop your bisphosphonates if you do need dental treatment later on. If in doubt, check with your doctor.
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