What Are The Side Effects Of Bisphosphonates?

side effects of bisphosphonates

Bisphosphonates are medications that are commonly used to manage osteoporosis and osteopenia. Some of these drugs are Alendronate, Risedronate, Ibandronate, and Zoledronic Acid. The side effects of bisphosphonates can suffer you for a long time.

These medications are recommended for treating bone mineral density loss. Bisphosphonates are usually prescribed to menopausal women because osteoporosis is more common in women during and after menopause. Biophosphonates slow down the process of bone loss. [1] [2]

Bisphosphonates are also used for treating Paget’s disease and some forms of bone cancer. While these medications are highly effective in treating bone diseases, they may also cause a few side effects of bisphosphonates

If you are taking bisphosphonates, it’s important to be aware of the side effects of bisphosphonates.

What are the side effects of bisphosphonates?

1. Muscle pain

One common side effect of bisphosphonates is pain in the muscles, bones, and joints. You may develop recurring body aches and stiffness. The best way to relieve these aches is gentle exercise. Drinking plenty of fluids may also help relieve these symptoms. [3]

2. Osteonecrosis of the jaw 

Osteonecrosis of the jaw or ONJ is one of the most serious adverse effects of bisphosphonates.  Osteonecrosis of the jaw occurs due to a reduced supply of blood to the tissues in the joint.

As a result, the joints in the jaw do not receive enough oxygen, calcium, and other nutrients. 

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The risk of ONJ linked to bisphosphonates can increase if the medication is taken for longer than 5 years. The incidence of ONJ among bisphosphonates recipients is 1 case per 100,000 people who’ve been on the drug for more than 5 years.[4]

For people taking bisphosphonates, most cases of ONJ occur after a tooth extraction or a dental infection.

ONJ may also occur during cancer treatments like radiation and the use of steroidal medications. Long term use of antiresorptive medications can also trigger ONJ. [5]

Fortunately, it’s possible to minimize, or even avoid, these side effects of bisphosphonates.

Maintaining good oral hygiene is the key to preventing ONJ while using bisphosphonates. Regular visits to a dentist can also help to reduce the risk of ONJ and you should have a dental check-up prior to using bisphosphonates. 

ONJ caused by using bisphosphonates to manage osteoporosis are usually helped with conservative treatment. Most patients are able to recover completely without the need for surgery.

3. Femur Fractures

There have been rare cases of unusual fractures of the femur (thigh bone) in patients using bisphosphonates for a longer than 5 years. [6]

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These fractures are termed unusual because they are different from fractures that usually occur because of reduced bone mineral density or improperly treated osteoporosis. 

If you use bisphosphonates for several years and experience recurrent pain in your hips or thigh bone, it is important to discuss it with your physician.

Pain or discomfort in the hips and thighs could be a warning sign of an impending atypical femoral fracture. [7]

Most patients experience these symptoms for several weeks or months before they develop a fracture in the femur. Being aware of the early signs of atypical femoral fractures linked to the use of bisphosphonates and seeking prompt medical intervention can help to avoid a fracture.

4. Kidney damage

Research has shown that bisphosphonates may affect kidney function. They can affect the process of blood filtration as blood passes through the kidneys and the body’s natural cleansing and detoxification processes are affected.

This may lead to the build-up of toxins and harmful metabolites in the body. [8]

Have a doctor assess your renal function before you start using bisphosphonates. Patients who suffer from a kidney disorder or are experiencing urinary symptoms should refrain from using bisphosphonates. [9]

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5. Acute Phase Reaction

A short-lasting, acute phase reaction can occur in patients receiving bisphosphonate therapy. It is characterized by fever and severe pain in the joints and muscles. These symptoms usually last for about 24 to 72 hours. 

In most cases, the reaction resolves spontaneously. Treatment with painkillers like acetaminophen may help to relieve these symptoms.

6. Hypocalcemia

Some patients using bisphosphonate drugs may develop transient hypocalcemia due to secondary hyperparathyroidism.  Patients are advised to increase their intake of calcium and vitamin D while using bisphosphonate. 

7. Esophageal Cancer 

The use of oral bisphosphonates appears to be associated with a higher risk of esophageal cancer. The increased risk could be attributed to the esophageal erosion caused due to these medications. [10]

However, it is possible to avoid this side effect by taking doses of bisphosphonate after meals. 

Other side effects of bisphosphonates include: [11]


  • Fever 
  • Flu-like symptoms
  • Changes in bowel movements
  • Atrial fibrillation 
  • Tiredness 
  • Reduced energy levels
  • Heartburn
  • Irritation of the food pipe 


Women who are using bisphosphonates for the treatment of osteoporosis, osteopenia, or any other bone disorder are advised to undergo regular follow-ups to assess any adverse effect of this medication on their health. 

Most side effects of bisphosphonates are mild. However, if you experience severe side effects, you might have to stop using bisphosphonates. Regular follow-ups and undergoing routine tests are the keys to getting optimum benefits while minimizing the risk of side effects. 

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  1. https://www.ncbi.nlm.nih.gov/books/NBK470248/
  2. https://pubmed.ncbi.nlm.nih.gov/26333528/
  3. https://www.versusarthritis.org/about-arthritis/treatments/drugs/bisphosphonates/
  4. www.ncbi.nlm.nih.gov/pmc/articles/PMC4399917
  5. https://pubmed.ncbi.nlm.nih.gov/17599853/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376663/
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207284/
  8. https://www.nof.org/patients/treatment/medicationadherence/side-effects-of-bisphosphonates-alendronate-ibandronate-risedronate-and-zoledronic-acid/
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704135/
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704135/
  11. https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/bisphosphonates/side-effects/general

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