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What Are Bisphosphonates?

Bisphosphonates are antiresorptive treatments and are used in the prevention and treatment of postmenopausal osteoporosis. They can help prevent fractures in people at moderate or high fracture risk and prevent bone loss for men and women taking steroids like Prednisone. Bisphosphonates work by slowing cells that break down bone (osteoclasts) allowing cells that build bone (osteoblasts) more time to work and reduce the imbalance. Actonel® and Fosamax® have also been approved by the FDA for the treatment of osteoporosis in men. Etidronate (Didronel®) was the first bisphosphonate used clinically in the United States and has been approved for the treatment of Paget’s disease, but not for osteoporosis.

How do I take a bisphosphonate pill?

It is very important to follow the instructions for taking a bisphosphonates because they are difficult to absorb. For maximum effectiveness, follow these instructions:

  • Take the pill first thing in the morning on an empty stomach.
  • Take the pill with a FULL 8 OZ glass of water. Do not use orange juice, coffee or any other beverage to take this medicine.
  • Do not eat food or drink other liquids for at least 30 minutes. Remain sitting or standing up (do not lie down) for 30 minutes after taking the medicine.

What are the bisphosphonate brands?

Listed by FDA approval dates

  • 1977: Didronel® (etidronate)
  • 1996: Fosamax® (alendronate)
  • 1998: Actonel® (risedronate)
  • 2005: Boniva® (ibandronate)
  • 2011: Reclast® (zolendronic acid)
  • 2012: Binosto® (alendronate sodium)

What are the generic bisphosphonates?

Listed by FDA approval dates

  • 2003: Generic Didronel® (etidronate)
  • 2008: Generic Fosamax® (alendronate)
  • 2012: Generic Boniva® (ibandronate)
  • 2013: Generic Reclast® (zolendronic acid)
  • 2014: Generic Actonel® (risedronate)

What are the side effects of bisphosphonates?

There is good long term safety data on the bisphosphonates; but as with any medication there are also side effects. The most common side effects include muscle aches, joint aches, stomach upset or heartburn.

There are also some rare side effects that have been associated with long term use of bisphosphonates. These include osteonecrosis of the jaw (ONJ) and atypical femur fractures.

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