Bisphosphonates are prescription medications used as the drugs of choice for patients with osteoporosis. Osteoporosis is the decline in bone density leading to increased fragility of bones, resulting in a greater risk of bone fractures. The most common bisphosphonates include alendronate, or the brand Fosamax; risedronate, or the brand Actonel; ibandronate, or the brand Boniva; and zoledronic acid, or the brand Reclast. These medications may produce many side effects.
Nausea and Indigestion
Nausea is a common side effect seen with the use of bisphosphonates. It is more common with zoledronic acid and risedronate, and may be seen in 5 to 18 percent of individuals. In alendronate and ibandronate, nausea may occur in about 5 percent of patients. Indigestion may occur in about 11 percent of individuals on risedronate, while only occurring in about 4 percent of patients on alendronate, ibandronate and zoledronic acid. The patient should be instructed to take the medication with a full glass of water and remain upright for at least 30 minutes after taking the dose to reduce stomach irritation, explains "Pharmacotherapy: A Pathophysiologic Approach."
Diarrhea or Constipation
Bisphosphonates can cause either diarrhea or constipation. Diarrhea is most common in risedronate, occurring in up to 20 percent of users; constipation also has the highest frequency and occurs in up to 13 percent, reports the "Drug Information Handbook." Ibandronate and zoledronic acid cause these adverse reactions in about 5 percent of patients. Diarrhea and constipation is less common in alendronate and may cause either adverse reaction in about 3 percent of users. These side effects can be treated with over-the-counter medication, but if they persist for more than 3 days, the patient should seek medical care immediately.
Pain
Bone, joint and muscle pain may occur in patients on bisphosphonates. The American Academy of Family Physicians explains that these types of pain may occur within days, weeks or years after starting a bisphosphonate. Risedronate and zoledronic acid are more commonly associated with these side effects. Risedronate may cause back pain in up 28 percent of individuals and joint pain in up to 33 percent. Zoledronic acid may cause joint and muscle pain in about 25 percent of users and bone pain in about 9 percent. Alendronate and ibandronate produce these side effects in about 6 percent of individuals. These side effects may subside with the discontinuation of the drug. Some patients have reported complete resolution of symptoms when the medication was stopped, while others have reported slow or incomplete relief.
References
- "Pharmacotherapy: A Pathophysiologic Approach"; Joseph T. Dipiro, Robert L. Talbert, et al.; 2008
- "Drug Information Handbook"; Charles F. Lacy, Lora L. Armstrong, et al.; 2009
- American Academy of Family Physicians: FDA Warns of Potential Side Effect of Bisphosphonate Use
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