BISPHOSPHONATES INFORMATION SHEET

Developed by Andy Thompson MD FRCPC

What are Bisphosphonates?

Bisphosphonates are a class of medications used to treat and prevent osteoporosis including osteoporosis related to chronic steroid (prednisone) use. There are currently three available oral Bisphosphonates in Canada: Alendronate (Fosamax®), Risedronate (Actonel®), and Etidronate (Didrocal®, Didronel®). Occasionally doctors use Bisphosphonates for other diseases such as Paget’s disease.

How do Bisphosphonates work?

Healthy bones are constantly being broken down and renewed. This process is a delicate balance of the breaking down of old bone (by cells called osteoclasts) and the rebuilding of new bone (by cells called osteoblasts). Bisphosphonates work by inhibiting the osteoclasts, slowing down the process of bone breakdown.

What is the usual dose of Bisphosphonates?

How do I Maximize the effect of the Bisphosphonate?

• Only a very small amount of the Bisphosphonate is absorbed into the body (0.5%). Therefore, you must follow the instructions very carefully when taking this medication.
• Be certain you are receiving adequate amounts of Calcium and Vitamin D either from your diet or from supplemental tablets. (Please see the Calcium & Vitamin D Information Sheet)

Who should NOT take Bisphosphonates?

• Patients who have had a previous allergic reaction to Bisphosphonates.
• Women who are pregnant, planning pregnancy, or breast feeding.
• Patients with advanced kidney disease.
• Patients with low levels of calcium in the blood (hypocalcemia).
• Patients unable to stand or sit upright for 30 minutes should not take oral Bisphosphonates.

When will I start to feel the effects of Bisphosphonates?

Most patients will not feel any effects from the Bisphosphonates. Your doctor may monitor your response with bone mineral density testing. Bisphosphonates are used to improve or stabilize the strength of your bones to prevent a fracture. They are often taken for many years.

What Medications are safe with Bisphosphonates?

Virtually all medications are safe to take with Bisphosphonates. An example of some of the medications which may be safely added to Bisphosphonates include: Acetaminophen (Tylenol), Prednisone, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Other DMARDs (i.e. Methotrexate, Sulfasalazine, Hydroxychloroquine, and Gold), and Biologics (i.e. Etanercept, Infliximab, Anakinra).

What are the side-effects of Bisphosphonates?

MORE COMMON side-effects include:

• Bloating, nausea, stomach pain, and heartburn
• Diarrhea or constipation
• Back pain or joint pain
• Headache

RARE side-effects include:

• Gastrointestinal Problems: Bisphosphonates can cause irritation to the lining of the stomach, esophagus, and intestine. This may result in:
• Pain or trouble when swallowing.
• Ulcers in the stomach or esophagus.

How can I help to minimize the side-effects of Bisphosphonates?

• Take your Bisphosphonate as prescribed by your doctor and attend regular follow-up visits.
• Remember not to lie down after taking your Bisphosphonate.

Do I need to have regular blood tests while taking a Bisphosphonate?

NO, you do not need to have regular blood tests while taking Bisphosphonates. However, your doctor will likely order blood tests to help follow the activity of your disease.

How do I stop the Bisphosphonate?

You do not need to wean yourself off the Bisphosphonate. It can simply be stopped. Please inform your doctor is you have stopped taking the medication.

What should I do if I miss a dose of a Bisphosphonate?

• If you forget to take your Bisphosphonates, skip the dose, and take your usual dose tomorrow.
• If you forgot to take yesterday’s dose, skip yesterday’s dose and take your usual dose for today.

Are Bisphosphonates safe in pregnancy?

• Bisphosphonates are not recommended for use in pregnancy.
• If you become pregnant while taking a Bisphosphonate NOTIFY YOUR DOCTOR IMMEDIATELY.
• Bisphosphonates should not be taken if you are breast feeding.