Bisphosphonates

What Are Bisphosphonates?

Frieda Wiley, PharmD, RPh
By Medically Reviewed by 
Reviewed:
Medically Reviewed

These drugs are used to treat several conditions associated with bone loss.

Bisphosphonates are a group of drugs used to help prevent and treat bone loss.

They're prescribed for people with osteopenia (softening of the bones), osteoporosis (brittle and easily broken bones), Paget's disease, and certain bone cancers.

These drugs work by interfering with the process through which the body breaks down bone tissue.

In some cases, bisphosphonates can halt this process altogether.

The following drugs belong to the bisphosphonate family:

Reclast and Zometa (zoledronic acid) are administered by intravenous (IV) injection once a year. The other bisphosphonates come in pills, taken orally.

Warnings and Precautions

Don't take bisphosphonates if you:

  • Are allergic to them
  • Have disorders of the food pipe (esophagus), including tears, holes, narrowing, or difficulty swallowing
  • Have severe kidney disease
  • Can't sit in an upright position for at least 30 minutes
  • Have low levels of calcium in your bloodstream

To avoid irritation to your stomach and food pipe, you must remain in an upright position for at least 30 minutes after taking a bisphosphonate by mouth.

Boniva requires you to remain upright for 1 hour.

Except for Altevia, all pill forms of bisphosphonates should be taken on an empty stomach before eating breakfast — generally 30 minutes beforehand.

Take Boniva on an empty stomach 1 hour before eating; Altevia should be taken after meals.

Bisphosphonates should be taken with a full glass of water only — no juice, coffee, soda, or flavored beverages.

Always take a bisphosphonate by itself. Wait at least 30 minutes (or 1 hour with Boniva) before taking any other medications or supplements.

Common Side Effects

The most common side effects of bisphosphonates are stomach irritation and heartburn, but these problems are often avoided by taking the medication correctly.

Other common side effects include:

  • Bone or joint pain, or generalized pain
  • Muscle cramps or aches
  • Nausea, constipation, diarrhea, or other stomach discomfort
  • Headache or dizziness
  • Head colds, sinus or throat infections, or the flu
  • Bladder infections
  • Tiredness or trouble sleeping

Drug Interactions

Ask your doctor or pharmacist about bisphosphonates if you're taking:

  • Calcium in any form, including calcium gluconate, antacids like Citrical (calcium citrate) or Tums (calcium carbonate), or a calcium supplement
  • Iron supplements like FeoSol (ferrous sulfate) or ferrous gluconate
  • Magnesium-containing drugs like Milk of Magnesia (magnesium hydroxide) or Maalox (magnesium with aluminum)
  • Diuretics or "water pills" such as Lasix (furosemide) or Edecrin (ethacrynic acid)
  • Antbiotics like Amphosin and Fungizone (amphotericin B), amikacin, or gentamicin