Purpose of review: Bisphosphonates are the most commonly used treatment for osteoporosis. The pharmacology of bisphosphonates suggests the possibility of discontinuing treatment for a period, and patients frequently ask about this. In an attempt to help answer these questions, this review will consider recent data relevant to continuing and discontinuing long-term bisphoshonate therapy and other osteoporosis therapy.
Also use healthy habits to help protect your bones. Don't take a bisphosphonate. Try healthy habits alone to protect your bones. This information may not be right for you if: You are a man. You are a woman who has not been through menopause. You have osteoporosis caused by another medical condition, such as cancer or a bone disease. Your doctor told you that you have osteoporosis because of a side effect of taking medicines, such as steroids.
Or you are taking steroids now or plan to start taking a long-term course of them. Key points to remember The decision about whether or not to take bisphosphonates depends on what your risk of a fracture is and how you feel about the pros and cons of your options. There isn't only one right decision. If you are at a higher risk of having a fracture, taking bisphosphonates is more likely to help you prevent a fracture. If your risk of a fracture is lower, it's less likely that these medicines will help you.
Your doctor might use the FRAX tool to help predict your risk of a fracture. Bisphosphonates can cause problems with the jaw or thigh bone. But most women do not have these side effects. They seem to be more likely if women take bisphosphonates for more than 5 years. Whether you take medicine or not, healthy habits can help protect your bones.
Get enough calcium and vitamin D. Get regular weight-bearing exercise. Avoid drinking too much alcohol. If you smoke, quit. Your doctor may suggest a different medicine depending on your health or if you are having a problem with side effects from bisphosphonates. What is osteoporosis? What is low bone density? Low bone density means you are at a higher risk for osteoporosis. What healthy habits can help protect your bones? Whether or not you take medicine, experts recommend that you: footnote 2 Get enough calcium and vitamin D.
Avoid smoking. What are bisphosphonates? They include: Alendronate Fosamax. Ibandronate Boniva. Risedronate Actonel or Atelvia. Zoledronic acid Reclast. How are they taken? What are the benefits of these medicines? The higher your risk of a fracture, the more likely it is that bisphosphonates can help prevent a fracture. The lower your risk of a fracture, the less likely it is that taking these medicines can help prevent a fracture. How can you find out your risk of a fracture?
Your risk depends on several things, including: Your age, height, and weight. If you've had a fracture in the past. If one of your parents ever fractured a hip.
If you smoke. How much alcohol you drink. The results of a bone density test, if you've had one. Who is helped the most by bisphosphonates? For women who have been through menopause: If you have osteoporosis your T-score is This includes lowering your risk of a hip fracture, which is a more harmful kind of fracture that can happen with osteoporosis. This evidence is not as strong. Experts recommend that you and your doctor think about not only your bone density but also those other things about you that affect your risk of having a fracture.
That will tell you how likely it is that taking bisphosphonates might prevent a fracture. What are the side effects of these medicines? Bone side effects Certain bone problems have been reported in women taking bisphosphonates. This is called osteonecrosis. Research has shown that bisphosphonates seem to increase the chance of this jaw problem.
If it happens, surgery may be needed. This is called an atypical fracture. More research is needed to find out if taking bisphosphonates is a cause of these fractures. How long would you need to take bisphosphonates?
Are there other medicines for osteoporosis or low bone density? Other medicines include: Denosumab Prolia. Hormone therapy HT or estrogen therapy ET.
Raloxifene Evista. Teriparatide Forteo. Compare your options. Compare Option 1 Take a bisphosphonate Try using healthy habits alone. Compare Option 2 Take a bisphosphonate Try using healthy habits alone. Take a bisphosphonate Take bisphosphonates You take bisphosphonate pills on a schedule such as once a week.
Or you may get a shot in a vein in your arm once a year. You and your doctor will discuss how long you'll take the medicines. You make sure you get enough calcium and vitamin D. You get regular weight-bearing exercise. Sign up to get tips for living a healthy lifestyle, with ways to fight inflammation and improve cognitive health , plus the latest advances in preventative medicine, diet and exercise , pain relief, blood pressure and cholesterol management, and more.
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Get answers to some of the most common questions about osteoporosis treatment. If you're undergoing osteoporosis treatment, you're taking a step in the right direction for your bone health. But perhaps you have questions about your therapy. Is the medication you're taking the best one for you?
How long will you have to take it? Why does your doctor recommend a weekly pill when your friend takes a pill only once a month? Another common osteoporosis medication is denosumab Prolia, Xgeva. Unrelated to bisphosphonates, denosumab might be used in people who can't take a bisphosphonate, such as some people with reduced kidney function. Denosumab is delivered by shallow injections, just under the skin, every six months. If you take denosumab, you might have to do so indefinitely unless your doctor transitions you to another medication.
Recent research indicates that there could be a high risk of spinal fractures after stopping the drug, so it's important that you take it consistently.
The main side effects of bisphosphonate pills are stomach upset and heartburn. Don't lie down or bend over for 30 to 60 minutes to avoid the medicine washing back up into the esophagus. Most people who follow these tips don't have these side effects. Bisphosphonate pills aren't absorbed well by the stomach. It may help to take the medication with a tall glass of water on an empty stomach.
Don't put anything else into your stomach for 30 to 60 minutes, after which you can eat, drink other liquids and take other medications. Intravenous forms of bisphosphonates, such as ibandronate and zoledronic acid, don't cause stomach upset. And it may be easier for some people to schedule a quarterly or yearly infusion than to remember to take a weekly or monthly pill. Intravenous bisphosphonates causes mild flu-like symptoms in some people, but usually only after the first infusion.
You can lessen the effect by taking acetaminophen Tylenol, others before and after the infusion. A very rare complication of bisphosphonates and denosumab is a break or crack in the middle of the thighbone. This injury, known as atypical femoral fracture, can cause pain in the thigh or groin that begins subtly and may gradually worsen.
Bisphosphonates and denosumab can also cause osteonecrosis of the jaw, a rare condition in which a section of jawbone is slow to heal or fails to heal, typically after a tooth is pulled or other invasive dental work. This occurs more commonly in people with cancer that involves the bone — who take much larger doses of a bisphosphonate than those typically used for osteoporosis. The risk of developing atypical femoral fracture or osteonecrosis of the jaw tends to increase the longer you take bisphosphonates.
So your doctor might suggest that you temporarily stop taking this type of drug. This practice is known as a drug holiday.
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