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Updated September 2022
Bisphosphonates are medicines used to treat bone diseases such as osteoporosis and Paget’s disease. Alendronate and risedronate are the most commonly prescribed bisphosphonate tablets in Australia.
Osteoporosis is a common disease of reduced bone mass leading to fragile and brittle bones that may break (fracture) more easily, even as a result of normal activity (as distinct from a fall). Fractures may be painful and restrict a person’s ability to carry out their normal daily tasks. In osteoporosis, bisphosphonates reduce the risk of a broken bone or fracture.
In Paget’s disease, the formation of abnormal bone causes deformity and pain. Bisphosphonate medicines can help this.
For more information about OSTEOPOROSIS see the Healthy Bones Australia website www.healthybonesaustralia.org.au or phone Healthy Bones Australia on 1800 242 141.
Bone undergoes constant turnover with old bone breaking down and new bone being formed to take its place. This usually happens in a balanced way. If the cycle becomes unbalanced, bone is broken down faster than it is replaced. This leads to osteoporosis.
Bisphosphonates slow or stop the bone breaking down. As a result, bone density may increase over time so the risk of fractures is reduced.
Since osteoporosis doesn’t usually have any symptoms such as pain (until a fracture occurs) you will not ‘feel’ any immediate benefit from your treatment with bisphosphonates.
If used for Paget’s disease, bone pain may lessen with time. Your doctor will explain the likely benefits relevant to you.
You may be asked to have tests to check the effect of treatment on your bones. For example, a bone mineral density test (DEXA scan) is usually done after one to two years of treatment. This is a type of x-ray, which involves a very small amount of radiation.
Tests of urine or blood are sometimes used to measure the effects of treatment on bone formation and breakdown.
Bisphosphonates come as tablets, but can also be given by injection (see separate information sheet).
It is important to follow the directions carefully to avoid side effects and to make sure the tablets work properly. Tablets should be taken swallowed whole with a glass of water and you should remain in an upright position ie, do not lie down immediately after swallowing the tablet. See Important things to remember at the bottom of this page, and ask your doctor about the instructions relevant to the medication you have been provided.
Tablets come in different strengths. The dose will depend on the type of bisphosphonate being taken and the condition for which it is being used.
For osteoporosis, the medicines are taken as a single tablet once a week or once a month for a number of years. For Paget’s disease they are usually taken daily for a limited period. Always follow the instructions provided in the packaging unless otherwise directed by a doctor.
It is safe to use most other medicines when you are taking bisphosphonates (see Precautions). However, bisphosphonates should not be taken with some other osteoporosis medicines (see Precautions).
It is also important not to take other medicines within 30 minutes of taking bisphosphonate tablets.
Your doctor may usually recommend you to take calcium and vitamin D supplements as well as your bisphosphonate. Some bisphosphonates are packaged in combination with vitamin D or calcium.
For osteoporosis, treatment with bisphosphonates is usually given for five years if the fracture risk is no longer high but continued up to an additional five years if the fracture risk remains high. Your doctor will review your progress each year.
For Paget’s disease, the treatment may be given for a shorter period of time.
Most people who take bisphosphonate tablets do not experience side effects. Tell your doctor if you are concerned about possible side effects. A reduction in dose or change to another medicine may minimise the side effects so that you can continue to have treatment for your bones.