What is a Bisphosphonate


If you’ve been diagnosed with osteoporosis you might be asking yourself “What is a Bisphosphonate?” because your doctor prescribed one or you read about them online.   Bisphosphonates are the medications that are commonly prescribed. These medicines can be effective by improving your bone mineral density, improving bone health, and reducing the risk of broken bones. [1]

Let’s take a look at the exact way bisphosphonates work for the prevention and treatment of osteoporosis. We will also review the side effects of bisphosphonates and the recommended doses of these drugs. 

So what exactly is a bisphosphonate?

Bisphosphonate refers to a family of drugs used for the treatment of osteoporosis. Bisphosphonates vary and are available under different brand names like Alendronate (Fosamax™, Fosamax™ Plus D), Risedronate (Actonel™, Actonel™ with Calcium, and Atelvia™),  Ibandronate (Boniva™),  Zoledronic acid (Reclast™), and in generic form. 

Bisphosphonates can regulate the processes involved in bone formation, bone resorption, and bone loss. The use of bisphosphonates in combination with improved dietary intake of calcium and vitamin D-rich foods can be an effective strategy to improve bone health and prevent fractures. [2]

In addition to treating osteopenia and osteoporosis, bisphosphonates may also be used for the treatment of other bone disorders like Paget’s disease and for improving bone health of patients where cancers that have spread to bone tissues.

Why would I take a bisphosphonate drug?

If you’ve been diagnosed with osteoporosis, then you may be prescribed a bisphosphonate.  As you know, osteopenia and osteoporosis are the conditions associated with weak or fragile bones having an increased risk for fractures. [3]

Regular use of bisphosphonates by women hav been shown to improve bone mineral density and prevent fractures in the hips, wrists, and other joints. It can also inhibit the weakness or fragility of the bones in the hips, arms, wrists, and spine. [4]

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The use of bisphosphonates is also sometimes recommended for women who have a family history of osteopenia and osteoporosis. It has been found that these bone disorders are more common in women whose mother or sister suffers from similar conditions.  But  we would recommend working closely with your doctor to understand the state of your bone health and trying exercise and diet as methods for improvement before using one of these drugs. [5] [6]

How does bisphosphonate work? 

Osteoporosis and osteopenia occur due to the loss of bone mineral density usually as a part of aging. The bone cells in the body are constantly being removed and later, replaced by new bone cells. This is a continuous process that occurs throughout our life. 

These processes are regulated by osteoclasts and osteoblasts. Osteoclasts are the cells that promote bone loss by removing old bone cells. The osteoblasts help in bone formation by producing new cells that can replace the lost bone tissues. 

The osteoblasts work more efficiently than the osteoclasts in children and adults. This helps to maintain their bone health without the risk of low bone mineral density. [7]

However, as age increases, the process of bone loss becomes faster compared to the process of bone formation. The ability of osteoblasts to form new cells to replace the old and damaged bone cells is reduced. As a result, more bone cells are removed compared to the number of cells produced to replace them. 

This makes the bones weak and fragile as well as more likely to fracture even after a minor fall or injury. 

The use of bisphosphonate medications can help to restore the healthy functioning of the osteoblasts and minimize the activities of the osteoclasts thereby preserving high bone density and bone strength. [8]

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Bisphosphonates primarily work by reducing the activity of the osteoclasts, lessening the removal of old bone and maintaining a healthy ratio of  turnover of bone cells. [9]  They also bind to the surface of the bones due to which the bone resorption processes stimulated by the osteoclasts are slowed down. This allows the bone-building osteoblasts to work more efficiently and  improves bone formation.

What is the recommended dose of Bisphosphonates?

The doses of bisphosphonates vary depending on the brand of the medication used. Most bisphosphonates are taken orally and must be taken on an empty stomach. You should remain upright for about 30 minutes after taking the doses and not eat anything during that period of time. Some forms of bisphosphonates are given as an infusion through a vein by a doctor in a clinic. 

What are the side effects of Bisphosphonates?

Bisphosphonates may cause side effects including:

  • Nausea
  • Abdominal pain
  • Irregular bowel movements
  • Pain in the joints and muscles

In some cases, bisphosphonates may cause osteonecrosis (deterioration) of the jaw leading to dental issues and tooth loss.   

In rare cases, the use of these drugs may result in ulceration in the esophagus. Patients who suffer from frequency heartburn, hyperacidity, or other digestive issues are advised to avoid high-fat foods to minimize these side effects. [10]

Here’s the scoop.

Including bisphosphonates in the management of bone health disorders could support the faster recovery of patients. Bisphosphonates influence the processes of bone loss and bone formation.  It’s important to consider all of the risks and benefits associated with these treatments by working closely with your doctor.


  1. https://pubmed.ncbi.nlm.nih.gov/29992180/
  2. https://www.ncbi.nlm.nih.gov/books/NBK470248/
  3. https://pubmed.ncbi.nlm.nih.gov/9875874/
  4. https://pubmed.ncbi.nlm.nih.gov/17476007/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3513863/
  6. https://pubmed.ncbi.nlm.nih.gov/26333528/
  7. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Treatments/Bisphosphonate-Therapy
  8. https://www.ncbi.nlm.nih.gov/pubmed/18775204
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2667901/
  10. https://www.nof.org/patients/treatment/medicationadherence/side-effects-of-bisphosphonates-alendronate-ibandronate-risedronate-and-zoledronic-acid/

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