Medications

Candidates. National Osteoporosis Foundation guidelines recommend that the following people should take or consider bisphosphonates:

• Women with a below-normal bone density of 2.5 SD or greater and no history of fractures.
• Women with below-normal bone density 1 SD or more and a history of fractures

Brands. Bisphosphonates are available in different forms:

• Oral bisphosphonates. These pills include alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva). Alendronate and risedronate are taken once a week. In 2005, ibandronate was approved as the first once-monthly pill. Risedronate is also available in a pill that contains calcium. Both risedronate and alendronate are approved for men as well as women.
• Intravenous bisphosphonates. In 2006, ibandronate (Boniva) was approved as the first intravenous form of bisphosphonate. It is given as an injection every 3 months in a doctor’s office for treatment of osteoporosis. This injectable form is an alternative for patients who may have difficulty swallowing pills or sitting upright after oral bisphosphonate treatment. Researchers are also investigating Reclast, a bisphosphonate that would be administered once a year as a 15-minute infusion. Reclast contains zoledronic acid, a drug used for treating cancer-related bone problems.

Side Effects. Bisphosphonates’ most distressing side effects are gastrointestinal problems, particularly stomach cramps and heartburn. These symptoms are very common and occur in nearly half of all patients. Other side effects may include irritation of the esophagus (the tube that connects the mouth to the stomach), and ulcers in the esophagus or stomach. Some patients may experience muscle and joint pain. To avoid stomach problems, doctors recommend:

• Take the pill on an empty stomach in the morning with 6 - 8 ounces of water (not juice, or carbonated or mineral water).
• After taking the pill, remain in an upright position. Do not eat or drink for at least 30 - 60 minutes. (Check your drug’s dosing instructions for exact time.)
• If you develop chest pain, heartburn, or difficulty swallowing, stop taking the drug and see your doctor.