Bisphosphonates for Paget's Disease of Bone

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Bisphosphonates for Paget's Disease of Bone


Generic NameBrand Name
zoledronic acidReclast

Some bisphosphonates, such as alendronate and risedronate, are taken by mouth (orally). Others, such as pamidronate and zoledronic acid, are given intravenously.

How It Works

Bisphosphonates decrease the number and activity of bone cells (osteoclasts) to reduce the breakdown of bone tissue. Bone has a more normal structure after bisphosphonate therapy.

Why It Is Used

Bisphosphonates decrease bone tissue breakdown. This leads to more normal bone structure and then to less pain and less risk of fracture.

Doctors may use bisphosphonates to help prevent complications in people who have Paget's disease but do not yet have symptoms. They also use bisphosphonates before surgery to decrease the activity of Paget's disease, so there is less risk of bleeding and complication from the surgery.

How Well It Works

Most often, bisphosphonates are the first medicines doctors use to treat Paget's disease and control its symptoms.

Bisphosphonates slow the rate of bone tissue breakdown and increase bone thickness in the spine and hip. This slows the progression of the disease. Bisphosphonates can also reduce symptoms that Paget's disease can cause, such as bone pain, ringing in the ears, dizziness, and numbness or weakness.

Bisphosphonates may take several months to become fully effective. Effects of bisphosphonates tend to last even after the person stops taking the medicine. In some cases, a person may need additional courses of the medicine to treat a return to active disease.

Reduction in laboratory markers such as alkaline phosphatase shows that the medicine is working to reduce the activity of Paget's disease. Some people eventually become resistant to one medicine, so it doesn't work as well to control their symptoms. When this happens, another bisphosphonate or another medicine may be effective.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.
  • Throwing up blood.
  • Black, tarry stools.

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

  • Hives.
  • Blood in your 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 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.
  • 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 take bisphosphonates.2 If you are taking bisphosphonates and need dental surgery, talk with your doctor.

Bisphosphonates are often used in cycles. They nearly always make Paget's disease inactive, sometimes for years or decades. But in some people Paget's disease becomes active again. You use bisphosphonates until pain decreases and lab tests show normal results. Then you take a break from the medicine for about 3 months or until lab tests show that Paget's disease is active again.

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 30 minutes 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. Lane N (2009). Paget's disease of bone section of Metabolic bone diseases. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 2, pp. 1593–1595. Philadelphia: Saunders Elsevier.
  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 ReviewerAnne C. Poinier, MD - Internal Medicine
Specialist Medical ReviewerJennifer Hone, MD - Endocrinology, Diabetes and Metabolism
Last RevisedMay 14, 2012

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