Bisphosphonates

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Bisphosphonates are a group of medicines used to treat conditions that affect your bones such as osteoporosis and Paget's disease.

  • Osteoporosis is a condition that causes your bones to be weaker than normal. This means that they can break (fracture) easily, such as after a small bump or fall. With osteoporosis, bisphosphonates prevent bone loss, increase bone thickness and lower your risk of spine and hip fractures.
  • In Paget's disease, the growth of abnormal bone causes deformity and pain. Bisphosphonates can help with this.
  • Bisphosphonates may also be used to reduce the high levels of calcium in the blood (called hypercalcaemia) associated with some cancers.

Examples of bisphosphonates

There are many bisphosphonates available in New Zealand. Some are available as tablets others are given by injection, as a drip into the vein (called intravenous infusion).

Each bisphosphonate has different uses and side effects. Which bisphosphonates is best for you depends on your health and the condition being treated. Your doctor will advise you on the best bisphosphonate for you.

Examples of bisphosphonates available in New Zealand

Tablets

Bisphosphonate tablets may not be suitable if you:

  • have problems with your stomach such as swallowing difficulties
  • are unable to stand or sit upright for longer than 30 minutes.

Injections

How to take bisphosphonates?

Tablets

Alendronate, etidronate and risedronate are taken either once a day, once a week (on the same day of the week), or as a course for 14 days followed by a break, depending on the one prescribed. The pharmacy label on your medicine will tell you how much to take, how often to take it, and any special instructions.

Take bisphosphonate tablets on an empty stomach.

  • Most people take their bisphosphonate first thing in the morning before they eat or drink anything. If you take a bisphosphonate with food, or drinks other than water, only a small amount of the medicine is absorbed.
  • You need to wait between 30 minutes and 2 hours before eating or drinking anything (other than water). The information leaflet that comes with your tablets will tell you exactly how long you should wait.
  • You need to swallow the tablet with a full glass of water and sit upright for 30 minutes afterwards. This is because bisphosphonates can irritate your oesophagus (the tube that takes food and drink from your mouth to your stomach.)

Injection

Bisphosphonate injections are given as a drip (infusion) into the vein, once a year or every 3 months depending on the type prescribed and the condition being treated. 

The infusion will take between 15 minutes and 4 hours. After the infusion, you may have to stay at the clinic or doctors surgery for observation, in case of any unwanted reaction.

Vitamin D and calcium supplements

It is important to take vitamin D supplements and have enough calcium (through the diet or supplements) while on bisphosphonate therapy.

The effects of bisphosphonates are not immediate

After starting your bisphosphonate, it may be a few months (6-12 months) before there is an increase in your bone density. This will then help to prevent breaks (fractures) of the hip and other bones such as the wrist. But you may still have a fracture while you are taking a bisphosphonate – they do not totally reduce your risk. They usually need to be taken for some years to see the full effect.

Possible side effects

Like all medicines, bisphosphonates can cause side effects, although not everyone gets them.

Problems with your jaw

Bisphosphonates can cause osteonecrosis of the jaw, which is a problem with the jaw, that can be caused by delayed healing in the mouth after some dental procedures. This is quite rare. To reduce the risk of this problem, it is best to:

  • Maintain good hygiene and care of your teeth and mouth (such as brushing your teeth twice a day and regular flossing between your teeth).
  • Have regular dental check-ups.
  • If you need any dental treatment, it is best that you have this done before you start your bisphosphonate. 
  • Let your dentist know that you are having bisphosphonate treatment.
  • Talk to your doctor or dentist if you have any loose teeth, tooth pain, or swelling or numbness in your jaw. 

Other side effects

Side effects What to do
  • Bloating (gas in the stomach)
  • Nausea (feeling sick)
  • Diarrhoea (loose stool)
  • This is quite common when you first start taking bisphosphonate tablets and usually settles with time.
  • Tell your doctor if troublesome.
  • Difficulty swallowing or pain when swallowing
  • Heartburn or indigestion
  • Chest pain
  • Bisphosphonate tablets can cause inflammation of the gut resulting in these side effects.
  • Tell your doctor immediately.
  • Flu-like symptoms such as muscle and joint pains, fever, headache
  • Irritation or burning at the site of the injection 
  • These symptoms are quite common with bisphosphonate injection. These symptoms tend to go away after a few days.
  • Your doctor can recommend a mild pain reliever such as ibuprofen or paracetamol to reduce these side effects.  
  • Tell your doctor if troublesome.
  • Eye pain
  • Red eye
  • Changes in your vision
  • Sensitive to light
  • Floating spots in your vision
  • These symptoms are related to inflammation in the eye. This is quite rare.
  • Contact your doctor immediately if you experience these symptoms.
  • Sore mouth or gums or loose teeth
  • Talk to your doctor or dentist and let them know you are taking bisphosphonates.

Learn more

The following links provide further information on bisphosphonates. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.

Bisphosphonates (tablets) Australian Rheumatology Association
Bisphosphonates (intravenous/IV) Australian Rheumatology Association
Bisphosphonates Patient Info, UK

References

  1. Bisphosphonates New Zealand Formulary
Credits: Sandra Ponen, pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 09 Oct 2018