Osteoporosis: Should I Take Bisphosphonate Medicines?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Osteoporosis: Should I Take Bisphosphonate Medicines?

1

Get the
Facts

2

Compare
Options

3

Your
Feelings

4

Your
Decision

5

Quiz
Yourself

6

Your Summary

Get the facts

Your options

Take a bisphosphonate to lower the risk of bone fractures. Also use healthy habits to help protect your bones.
Don't take a bisphosphonate. Try healthy habits alone to protect your bones.

Is this information for you?

This information may be right for you if:

You are a woman who has been through menopause or a man over the age of 50 and:
- You have osteoporosis or have had a fracture in your hip or spine.
- You have low bone density (osteopenia), and you are at high risk for a fracture.
You are on long-term steroid treatment and are at high risk for a fracture.
Your doctor has recommended bisphosphonates for other medical conditions.
You take medicines that may cause osteoporosis.

This information may not be right for you if:

You have kidney disease.
You have esophagus problems.
You are pregnant or breastfeeding.
You have low calcium levels in your blood.

If you're not sure if this information is for you, talk with your doctor about this decision.

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. Your doctor might use the FRAX tool to help predict your risk of a fracture. 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.
Whether you take medicine or not, healthy habits can help protect your bones. Get enough calcium and vitamin D. Get regular weight-bearing exercise or do resistance training. Avoid drinking too much alcohol. If you smoke, try to quit. Talk to your doctor if you need help quitting.
Bisphosphonates aren't right for everyone. Your doctor may suggest a different medicine depending on your health or if you are having a problem with side effects from bisphosphonates.

FAQs

What is osteoporosis?

Osteoporosis is a disease that affects your bones. It means you have bones that are thin and brittle, with lots of holes inside them like a sponge. This makes them easy to break. These fractures can be disabling and make it hard for you to live on your own.

What is low bone density?

Low bone density means you are at a higher risk for osteoporosis.

Low bone density is sometimes called osteopenia. It's important to know that low bone density is not a disease. Not everyone with low bone density gets osteoporosis or has a fracture. If you have low bone density and a high FRAX score, your doctor may recommend bisphosphonates. You both will decide if these medicines are right for you.

Your doctor may suggest a test to find out your bone density, depending on your age and your health.

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.
Get regular weight-bearing exercise or do resistance training.
Avoid drinking too much alcohol.
Avoid smoking.

Most of these healthy habits are good for your body for other reasons, too. For example, it's good for your heart if you get regular physical activity, avoid drinking too much, and avoid smoking.

Some people decide with their doctors that they want to try healthy habits alone without taking bisphosphonates. Your doctor will probably ask you to check in over time to see how that plan is working. Having your doctor keep track of your risk of a fracture will help you know if healthy habits alone are still enough to protect your bones.

What are bisphosphonates?

Bisphosphonates are the most common medicines used to prevent bone loss in people who have osteoporosis or have a high risk of a fracture. They slow the way bone dissolves and is absorbed by your body. They can increase bone thickness and strength.

They include:

Alendronate (Fosamax or Bisnosto).
Ibandronate (Boniva).
Risedronate (Actonel or Atelvia).
Zoledronic acid (Reclast).

How are they taken?

Different kinds of bisphosphonates are taken in different ways. Many are taken once a week. Others are taken once a day or once a month.

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.

Zoledronic acid is injected into a vein in your arm. Most people who use it get just one dose each year. One form of ibandronate is also given in a vein, usually every 3 months.

What are the benefits of these medicines?

Some people may benefit more from taking bisphosphonates than other people. It's important to find out your risk of having a fracture.

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 doctor can help you understand your risk of having 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.
If you have certain health conditions.
If you use certain medicines.

Your doctor might use the FRAX tool to help predict your risk of having a fracture related to osteoporosis in the next 10 years. You can use this tool too. Go to the website at www.sheffield.ac.uk/FRAX, and click on Calculation Tool. If you have had a bone density test on your hip, you can enter your score. If you haven't had that test, you can leave the score blank.

Who is helped the most by bisphosphonates?

For women who have been through menopause, men over the age of 50, and others with certain health conditions:

If you have osteoporosis (your T-score is -2.5 or less) or you have had a fracture in your hip or spine, taking bisphosphonates lowers your risk of having a fracture. This includes lowering your risk of a hip fracture, which is a more harmful kind of fracture that can happen with osteoporosis.
If you haven't had a fracture and you have low bone density (your T-score is between -1.0 and -2.5, sometimes called osteopenia), taking bisphosphonates might lower your risk of having a fracture. Experts recommend that you and your doctor think about your bone density and other risks you have for a fracture. That will tell you how likely it is that taking bisphosphonates might prevent a fracture.^{footnote 3, footnote 2, footnote 5}

What are the side effects of these medicines?

Side effects can happen while taking bisphosphonate pills. For example, some people feel heartburn or irritation of the esophagus. These side effects can usually be avoided by following the instructions for taking your medicine.

If you start taking bisphosphonates and have problems with side effects, you can try other medicines. Talk with your doctor.

Rarely, certain bone problems have been reported in people taking bisphosphonates. These include problems with the jaw and fracture of the thighbone. More research is needed to find out if taking bisphosphonates is a cause of these problems. Out of 1,000 people, about 1 person has a bone side effect during a year of taking bisphosphonates. That means 999 out of 1,000 people do not have a bone side effect.^{footnote 4, footnote 1}

How long would you need to take bisphosphonates?

Doctors don't know for sure how long people need to take bisphosphonates. That's because there hasn't been enough research to show how helpful these medicines are if you take them for more than 5 years.^{footnote 2}

If you decide to take bisphosphonates, you and your doctor can talk over time about how long to take them, based on your fracture risk and other factors. Your doctor will recheck your bone health in 3 to 5 years. The doctor may recommend you take a break from the medicines at some point.

Are there other medicines for osteoporosis or low bone density?

Bisphosphonates aren't right for everyone. Depending on your health, your doctor may suggest other medicines to help prevent bone loss. Or your doctor may suggest these other medicines if you are having a problem with side effects from bisphosphonates.

Other medicines include:

Denosumab (Prolia).
Hormone therapy (HT).
Raloxifene (Evista).
Teriparatide (Forteo).

Compare your options

Compare


What is usually involved?
What are the benefits?
What are the risks and side effects?

Take a bisphosphonateTake bisphosphonates

You take bisphosphonate pills on a schedule such as once a week. Or you may get an injection 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 or you do resistance training. And you avoid drinking too much alcohol and smoking.

The higher your fracture risk, the more likely it is that bisphosphonates can help prevent a fracture. The lower your fracture risk, the less likely it is that these medicines can help prevent a fracture.
If you have osteoporosis or you have had a fracture, taking bisphosphonates lowers your risk of a fracture.
If you have low bone density and are at high risk for a fracture, taking bisphosphonates can lower your risk of a fracture.

Some people feel heartburn or irritation of the esophagus.
Side effects can usually be avoided by following the instructions for taking the medicine.

Try using healthy habits aloneTry using healthy habits alone

You make sure you get enough calcium and vitamin D.
You get regular weight-bearing exercise or you do resistance training. And you avoid drinking too much alcohol and smoking.
You will need to check in with your doctor over time to see if using healthy habits alone is still enough to protect your bones.

You may be able to slow bone loss enough without taking medicines.
You avoid the possible side effects and cost of bisphosphonates.
Most of these healthy habits are good for your body for other reasons, too.

Especially if you are at a higher risk of fractures, using healthy habits alone won't lower your risk as much as taking bisphosphonates.

Personal stories about taking bisphosphonate medicines

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

My doctor told me that I have a few risk factors for getting osteoporosis. My mother had it, and my bone density is low. Since I'm at a higher risk, I decided to take bisphosphonates and find a weight-bearing activity I can stick with. I have small bones like my mother, and she suffered terribly after she broke her hip.

Clarissa, age 60

I was bummed when my doctor said my bone density is a little low. But then she said, "It's not just about your bone density, Joy. We need to look at your overall risk of a fracture." When she showed me the numbers, my risk was pretty small. And my doctor said, "You're already doing all the right things to protect your bones." I like to jog and lift weights. So we decided I'll just keep doing what I'm doing, and we'll keep an eye on my risk over time.

Joy, age 56

I broke my hip when I fell in the bathroom. My doctor says I have osteoporosis. He told me why experts recommend medicine for people like me. I don't like pills, but I definitely don't want to break another bone. I'm going to take the medicines.

Jack, age 77

My doctor used her computer to figure out my risk of breaking a bone. My risk looked pretty high. I was worried. She said bisphosphonates would lower my risk. I was worried they might give me heartburn. But she said that if I follow the instructions, I can probably avoid that side effect. I decided to give them a try.

Brenda, age 65

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take bisphosphonate medicines

Reasons to try healthy habits alone

I'm worried about my risk of a fracture, and I want to do everything I can to lower it.

I'm not very worried about my risk of a fracture.

More important

Equally important

More important

I don't mind taking pills or getting shots if it will reduce my risk of a fracture.

I don't like the idea of taking pills or getting shots.

More important

Equally important

More important

I'm already doing everything I can to help protect my bones through healthy habits.

I could do more to protect my bones by improving my healthy habits.

More important

Equally important

More important

I'm not worried about the side effects of these medicines.

I am worried about the side effects of these medicines.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking bisphosphonates

Trying healthy habits alone

Leaning toward

Undecided

Leaning toward

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient choices

What matters to you

Print Summary

Credits and References

Credits

Author	Ignite Healthwise, LLC Staff
Clinical Review Board	Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

References

Citations

Khan AA, et al. (2015). Diagnosis and management of osteonecrosis of the jaw: A systematic review and international consensus. Journal of Bone and Mineral Research, 30(1): 3–23. DOI: 10.1002/jbmr.2405. Accessed January 31, 2017.
LeBoff MS, et al. (2022). The clinician's guide to prevention and treatment of osteoporosis. Osteoporosis International, 33(10): 2049–2102. DOI: 10.1007/s00198-021-05900-y. Accessed April 24, 2023.
Qaseem A, et al. (2017). Treatment of low bone density or osteoporosis to prevent fractures in men and women: a clinical practice guideline update from the American College of Physicians. Ann Intern Med, 166(11):818–839. DOI: 10.7326/M15-1361. Accessed October 2, 2017.
Schilcher J, et al. (2014). Risk of atypical femoral fracture during and after bisphosphonate use. New England Journal of Medicine, 371(10): 974–976. DOI: 10.1056/NEJMc1403799. Accessed January 30, 2017.
U.S. Preventive Services Task Force, et al. (2018). Screening for osteoporosis to prevent fractures: U.S. Preventive Services Task Force recommendation statement. JAMA, 319(24): 2521–2531. DOI: 10.1001/jama.2018.7498. Accessed October 29, 2018.

Osteoporosis: Should I Take Bisphosphonate Medicines?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Take a bisphosphonate to lower the risk of bone fractures. Also use healthy habits to help protect your bones.
Don't take a bisphosphonate. Try healthy habits alone to protect your bones.

Is this information for you?

This information may be right for you if:

You are a woman who has been through menopause or a man over the age of 50 and:
- You have osteoporosis or have had a fracture in your hip or spine.
- You have low bone density (osteopenia), and you are at high risk for a fracture.
You are on long-term steroid treatment and are at high risk for a fracture.
Your doctor has recommended bisphosphonates for other medical conditions.
You take medicines that may cause osteoporosis.

This information may not be right for you if:

You have kidney disease.
You have esophagus problems.
You are pregnant or breastfeeding.
You have low calcium levels in your blood.

If you're not sure if this information is for you, talk with your doctor about this decision.

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. Your doctor might use the FRAX tool to help predict your risk of a fracture. 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.
Whether you take medicine or not, healthy habits can help protect your bones. Get enough calcium and vitamin D. Get regular weight-bearing exercise or do resistance training. Avoid drinking too much alcohol. If you smoke, try to quit. Talk to your doctor if you need help quitting.
Bisphosphonates aren't right for everyone. Your doctor may suggest a different medicine depending on your health or if you are having a problem with side effects from bisphosphonates.

FAQs

What is osteoporosis?

What is low bone density?

Low bone density means you are at a higher risk for osteoporosis.

Your doctor may suggest a test to find out your bone density, depending on your age and your health.

What healthy habits can help protect your bones?

Whether or not you take medicine, experts recommend that you:²

Get enough calcium and vitamin D.
Get regular weight-bearing exercise or do resistance training.
Avoid drinking too much alcohol.
Avoid smoking.

Most of these healthy habits are good for your body for other reasons, too. For example, it's good for your heart if you get regular physical activity, avoid drinking too much, and avoid smoking.

What are bisphosphonates?

They include:

Alendronate (Fosamax or Bisnosto).
Ibandronate (Boniva).
Risedronate (Actonel or Atelvia).
Zoledronic acid (Reclast).

How are they taken?

Different kinds of bisphosphonates are taken in different ways. Many are taken once a week. Others are taken once a day or once a month.

Zoledronic acid is injected into a vein in your arm. Most people who use it get just one dose each year. One form of ibandronate is also given in a vein, usually every 3 months.

What are the benefits of these medicines?

Some people may benefit more from taking bisphosphonates than other people. It's important to find out your risk of having a fracture.

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 doctor can help you understand your risk of having 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.
If you have certain health conditions.
If you use certain medicines.

Who is helped the most by bisphosphonates?

For women who have been through menopause, men over the age of 50, and others with certain health conditions:

If you have osteoporosis (your T-score is -2.5 or less) or you have had a fracture in your hip or spine, taking bisphosphonates lowers your risk of having a fracture. This includes lowering your risk of a hip fracture, which is a more harmful kind of fracture that can happen with osteoporosis.
If you haven't had a fracture and you have low bone density (your T-score is between -1.0 and -2.5, sometimes called osteopenia), taking bisphosphonates might lower your risk of having a fracture. Experts recommend that you and your doctor think about your bone density and other risks you have for a fracture. That will tell you how likely it is that taking bisphosphonates might prevent a fracture.^{3, 2, 5}

What are the side effects of these medicines?

If you start taking bisphosphonates and have problems with side effects, you can try other medicines. Talk with your doctor.

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).
Raloxifene (Evista).
Teriparatide (Forteo).

2. Compare your options

	Take bisphosphonates	Try using healthy habits alone
What is usually involved?	You take bisphosphonate pills on a schedule such as once a week. Or you may get an injection 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 or you do resistance training. And you avoid drinking too much alcohol and smoking.	You make sure you get enough calcium and vitamin D. You get regular weight-bearing exercise or you do resistance training. And you avoid drinking too much alcohol and smoking. You will need to check in with your doctor over time to see if using healthy habits alone is still enough to protect your bones.
What are the benefits?	The higher your fracture risk, the more likely it is that bisphosphonates can help prevent a fracture. The lower your fracture risk, the less likely it is that these medicines can help prevent a fracture. If you have osteoporosis or you have had a fracture, taking bisphosphonates lowers your risk of a fracture. If you have low bone density and are at high risk for a fracture, taking bisphosphonates can lower your risk of a fracture.	You may be able to slow bone loss enough without taking medicines. You avoid the possible side effects and cost of bisphosphonates. Most of these healthy habits are good for your body for other reasons, too.
What are the risks and side effects?	Some people feel heartburn or irritation of the esophagus. Side effects can usually be avoided by following the instructions for taking the medicine.	Especially if you are at a higher risk of fractures, using healthy habits alone won't lower your risk as much as taking bisphosphonates.

Personal stories

Personal stories about taking bisphosphonate medicines

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"My doctor told me that I have a few risk factors for getting osteoporosis. My mother had it, and my bone density is low. Since I'm at a higher risk, I decided to take bisphosphonates and find a weight-bearing activity I can stick with. I have small bones like my mother, and she suffered terribly after she broke her hip."

— Clarissa, age 60

"I was bummed when my doctor said my bone density is a little low. But then she said, "It's not just about your bone density, Joy. We need to look at your overall risk of a fracture." When she showed me the numbers, my risk was pretty small. And my doctor said, "You're already doing all the right things to protect your bones." I like to jog and lift weights. So we decided I'll just keep doing what I'm doing, and we'll keep an eye on my risk over time."

— Joy, age 56

"I broke my hip when I fell in the bathroom. My doctor says I have osteoporosis. He told me why experts recommend medicine for people like me. I don't like pills, but I definitely don't want to break another bone. I'm going to take the medicines."

— Jack, age 77

"My doctor used her computer to figure out my risk of breaking a bone. My risk looked pretty high. I was worried. She said bisphosphonates would lower my risk. I was worried they might give me heartburn. But she said that if I follow the instructions, I can probably avoid that side effect. I decided to give them a try."

— Brenda, age 65

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take bisphosphonate medicines

Reasons to try healthy habits alone

I'm worried about my risk of a fracture, and I want to do everything I can to lower it.

I'm not very worried about my risk of a fracture.

More important

Equally important

More important

I don't mind taking pills or getting shots if it will reduce my risk of a fracture.

I don't like the idea of taking pills or getting shots.

More important

Equally important

More important

I'm already doing everything I can to help protect my bones through healthy habits.

I could do more to protect my bones by improving my healthy habits.

More important

Equally important

More important

I'm not worried about the side effects of these medicines.

I am worried about the side effects of these medicines.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking bisphosphonates

Trying healthy habits alone

Leaning toward

Undecided

Leaning toward

Credits

By	Ignite Healthwise, LLC Staff
Clinical Review Board	Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

References

Citations

Khan AA, et al. (2015). Diagnosis and management of osteonecrosis of the jaw: A systematic review and international consensus. Journal of Bone and Mineral Research, 30(1): 3–23. DOI: 10.1002/jbmr.2405. Accessed January 31, 2017.
LeBoff MS, et al. (2022). The clinician's guide to prevention and treatment of osteoporosis. Osteoporosis International, 33(10): 2049–2102. DOI: 10.1007/s00198-021-05900-y. Accessed April 24, 2023.
Qaseem A, et al. (2017). Treatment of low bone density or osteoporosis to prevent fractures in men and women: a clinical practice guideline update from the American College of Physicians. Ann Intern Med, 166(11):818–839. DOI: 10.7326/M15-1361. Accessed October 2, 2017.
Schilcher J, et al. (2014). Risk of atypical femoral fracture during and after bisphosphonate use. New England Journal of Medicine, 371(10): 974–976. DOI: 10.1056/NEJMc1403799. Accessed January 30, 2017.
U.S. Preventive Services Task Force, et al. (2018). Screening for osteoporosis to prevent fractures: U.S. Preventive Services Task Force recommendation statement. JAMA, 319(24): 2521–2531. DOI: 10.1001/jama.2018.7498. Accessed October 29, 2018.

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Current as of: July 31, 2024

Author: Ignite Healthwise, LLC Staff

Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.