Bisphosphonates for Osteoporosis

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Bisphosphonates for Osteoporosis


Generic NameBrand Name
risedronateActonel, Atelvia
zoledronic acidReclast

You take most bisphosphonates by mouth—every day, once or twice a week, or even once a month. Zoledronic acid is given intravenously (IV), usually only once each year. One form of ibandronate is also given intravenously, usually every 3 months.

How It Works

Bisphosphonates are antiresorptive medicines, which means they slow or stop the natural process that dissolves bone tissue, resulting in maintained or increased bone density and strength. This may prevent the development of osteoporosis. If osteoporosis already has developed, slowing the rate of bone thinning reduces the risk of broken bones.

Bisphosphonates may be taken by men or women.

Why It Is Used

Bisphosphonates are commonly used for the prevention and treatment of osteopenia and osteoporosis.

Bisphosphonates are also used to treat other bone diseases such as Paget's disease.

How Well It Works

Studies show that bisphosphonates increase bone thickness and may lower the risk of fractures.1

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor if you are taking bisphosphonates by mouth and you have:

  • Hives.
  • Trouble swallowing (dysphagia).
  • Muscle pain or cramps.
  • Stomach pain.

Call your doctor if you are taking intravenous (IV) bisphosphonates and you have:

  • Hives.
  • Blood in the urine.
  • Dizziness.
  • Unusual tiredness or weakness.
  • Muscle pain or cramps.

Common side effects of this medicine include:

  • Heartburn and irritation of the tube that connects the throat to the stomach (esophagus), if you are taking bisphosphonate pills. These side effects can usually be avoided by following the instructions for taking your medicine.
  • Headache; constipation, diarrhea, and passing gas; and muscle and joint pain, if you are taking intravenous (IV) bisphosphonate shots.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Bisphosphonates are not usually recommended for people with severe kidney disease. Your doctor will test your kidney function before prescribing bisphosphonates, especially if you are considering zoledronic acid (Reclast).

If you are considering a bisphosphonate that is taken by mouth, be sure to tell your doctor if you have ever had serious heartburn or problems with your esophagus (the tube that connects your throat to your stomach).

For the best results and to reduce the risk of irritation to your esophagus if you take bisphosphonates by mouth:

  • Most of these medicines should be taken in the morning with a full glass of water at least 30 minutes before eating a meal, drinking a beverage, or taking any other medicine. If your doctor prescribes the form of risedronate called Atelvia, take it right after breakfast with a glass of water.
  • Sit or stand (don't lie down) for at least 30 minutes after taking a bisphosphonate. This helps prevent heartburn.
  • Do not take a bisphosphonate late in the day if you forgot to take it in the morning.

Tell your doctor if you notice any new or increasing problems with swallowing. Problems could include feeling pain when you swallow or feeling like you have a lump or sore in your throat.

Tell your doctor if you notice pain in your thigh or groin. Some research suggests that taking bisphosphonates for a long time may slightly increase the risk of breaking the thigh bone.

Serious problems with bone healing, particularly after dental surgery, have been found in some people who are taking bisphosphonates.2 If you are taking bisphosphonates and need dental surgery, talk with your doctor.

It is not clear how long you should take bisphosphonates. Experts have suggested that taking bisphosphonates for 3 to 5 years may be enough if you are at low risk of fractures. Talk to your doctor about how long you should take these medicines.

If you are taking bisphosphonates, your doctor may also recommend that you take calcium and vitamin D supplements. But calcium supplements may interfere with your body's ability to absorb bisphosphonates, so take your bisphosphonate and your calcium supplement at least half an hour apart.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.


Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.



  1. Drugs for postmenopausal osteoporosis (2011). Treatment Guidelines From The Medical Letter, 9(111): 67–74.
  2. Woo S-B, et al. (2006). Systematic review: Bisphosphonates and osteonecrosis of the jaw. Annals of Internal Medicine, 144(10): 753–761.


ByHealthwise Staff
Primary Medical ReviewerKathleen Romito, MD - Family Medicine
Specialist Medical ReviewerCarla J. Herman, MD, MPH - Geriatric Medicine
Last RevisedNovember 6, 2012

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