Bisphosphonates: Osteoporosis Medications That May Help Prevent Spinal Fractures

Osteoporosis is a metabolic bone disease that decreases bone mineral density (BMD)—the inner strength of bones. Loss of BMD increases the risk for spinal fracture. There are many types of medications available to help prevent osteoporosis-related fractures. This article is about a specific class of drugs call bisphosphonates. These medications help increase bone mineral density in the spine (and hips) and may help reduce the risk of fracture.

Drugs called bisphosphonates (alendronate, ibandronate, risedronate, and zoledronic acid) are among the first drugs a doctor considers to treat osteoporosis. Your family and medical history, including your age and sex are determinants as to the medication your doctor prescribes.
Alendronic acid (alendronate, bisphosphonate class) osteoporosis drug, chemical structure

Alendronate Sodium or Alendronate Sodium plus Vitamin D3 (Cholecalciferol)

Brand Names: Fosamax, Binosto, Fosamax Plus D

What it does: It prevents and treats osteoporosis in postmenopausal women and in men. It reduces bone loss, increases bone mineral density and reduces the risk of bone fractures.

How to take it: Alendronate is taken daily or weekly in tablet form. Alendronate is available in different forms.

One type of alendronate is combined with a type of vitamin D called cholecalciferol. Vitamin D helps the body to absorb calcium. Alendronate is also available as an effervescent tablet, which is dissolved in plain water before it is taken.

  • It is very important to take alendronate on an empty stomach with plain water, before your first food or drink, and before you take your other medications.
  • Wait at least 30 minutes before you lie down after taking alendronate.
  • You may sit, stand or walk and do normal activities after taking alendronate.
  • Regular alendronate tablets should be swallowed whole.
  • Do not chew or crush the tablet.

Potential side effects: Bone, joint or muscle pain; nausea, difficulty swallowing, heartburn, irritation of the esophagus, gastric ulcer or severe problems with bones in the jaw.

Who shouldn’t take it: Women who are pregnant or nursing, people who have low levels of calcium in the blood, or people with severe kidney disease. Persons that have problems with their esophagus or are unable to stand or sit upright for at least 30 minutes.

Ibandronate Sodium

Brand Name: Boniva (oral tablet and intravenous injection)

What it does: It prevents and treats osteoporosis in postmenopausal women.

How to take it: Take the oral tablet with a full glass of plain water at least 60 minutes before any food, other drink or medications. Avoid lying down for at least 60 minutes after taking tablet. Intravenous injection is given every three months in a doctor’s office.

Potential side effects: Bone, joint or muscle pain.

  • Side effects of the oral tablets may include nausea, difficulty swallowing, heartburn, irritation of the esophagus, gastric ulcer or severe problems with bones in the jaw.
  • Side effects that can occur shortly after receiving an IV infusion include flu-like symptoms, fever, headache and pain in muscles or joints. These side effects generally last for a few days.

Who shouldn’t take it: Women who are pregnant or nursing, people who have low levels of calcium in the blood, and people who have severe kidney disease.

Testing required: Patients need to have a blood test (serum creatinine) to confirm that kidney function is normal before each IV injection.

Missed doses: If you miss your dose of medication, please contact your pharmacist or primary care provider to receive further instructions.

Risedronate Sodium

Brand Names:  Actonel, Atelvia

What it does: It slows bone loss, increases BMD and reduces the risk of spine and other bone fractures.

  • Actonel treats and helps to prevent osteoporosis in postmenopausal women and treats osteoporosis in men.
  • Atelvia treats osteoporosis in postmenopausal women.

How to take it: Daily, weekly, twice monthly or monthly in tablet form. There are immediate release and delayed release tablets.

  • Take immediate release tablets with a full glass of plain water at least 30 minutes before any food, drink or other medications.
  • Delayed release tablets are taken with plain water immediately after eating breakfast.
  • Tablets should be swallowed whole; do not crush or chew the tablet.
  • As with other bisphosphonates, remain upright (sit, stand or walk) for at least 30 minutes after taking medication to avoid irritating the esophagus.

Potential side effects: Bone, joint or muscle pain; nausea, difficulty swallowing, heartburn, irritation of the esophagus, gastric ulcer or severe problems with bones in the jaw.

Who shouldn’t take it: Women who are pregnant or nursing; people who have low levels of calcium in the blood; and people who have severe kidney disease.

Zoledronic Acid

Brand Name: Reclast

What it does: It helps to treat and prevent osteoporosis in postmenopausal women; increases bone mass in men with osteoporosis; prevents new fractures in patients who have recently had a low-trauma hip fracture. It increases BMD and reduces the risk for spinal fractures and other bones (eg, wrist, hips). It treats or prevents osteoporosis in men or women who will be taking corticosteroid medicines (such as prednisone) for at least one year.

How to take it: Once a year as an intravenous (IV) infusion, or every two years as an IV infusion to prevent osteoporosis (in a doctor’s office).

Potential side effects: Bone, joint or muscle pain. Side effects that can occur shortly after receiving an IV infusion include flu-like symptoms, fever, chills, headache and pain in muscles or joints. The side effects generally will last for a short time period. Severe problems with bones in the jaw can also occur.

Who shouldn’t take it: Women who are pregnant or nursing; people who have low levels of calcium in the blood; people who have severe kidney disease.

Testing required: Patients need to have a blood test prior to each IV dose to measure creatinine to confirm that kidney function is normal. Calcium levels are recommended to be measured to confirm that the blood calcium level is normal before starting therapy.

Your bone mineral density (BMD) should be evaluated every 1-2 years. If you have a severe reaction to any of the above medications, contact your health care provider.

Updated on: 06/09/16
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Calcium and Vitamin D to Build Bone

If you have osteoporosis and are prone to fractures, it's important to get enough calcium. How much calcium you need depends on many factors.
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