Osteoporosis, which is characterized by abnormal bone loss, impacts millions of patients worldwide. Bisphosphonates are drugs that prevent bone loss by inhibiting the action of osteoclasts, the cells that break down bony tissue. Since their introduction over 10 years ago, they have become the standard of care for millions of patients with osteoporosis. They are also important treatments in other bone-related diseases including Paget's disease, bone metastasis and multiple myeloma. The bisphosphonate drugs include Fosamax, Boniva, Actonel and Reclast and are taken by mouth or intravenously.
Mild Side Effects
Generally, bisphosphonates are well tolerated with few side effects, in part because they bind selectively to their target tissue, bone. However, as with all drugs, different patients may manifest different side effects. Common side effects include hypocalcemia, or low levels of calcium in the blood; this is detected by blood tests. Fever and flu-like symptoms are also common but generally last only a few days. Bone and joint pain have also been reported and are generally treated with mild painkillers such as Tylenol. Low energy levels and weariness may also occur in some patients but are usually mild.
Upper GI Irritation
When taken by mouth, bisphosphonates can cause various forms of upper GI irritation including heartburn, esophageal irritation and abdominal pain. The esophagus is the muscular canal that connects the mouth to the stomach. To reduce these problems, the pills should be flushed down with about 4 ounces of water. Patients should also take their pills in the morning before eating or drinking, in an upright position.
Osteonecrosis of the Jaw
Osteonecrosis of the jaw is a rare side effect of bisphosphonates. This is an irreversible condition in which a patient's jawbone decays and dies. It is very painful and often disfiguring as a part of the jawbone may be removed. According to Woo and colleagues, 94 percent of published cases of osteonecrosis of the jaw were in patients with multiple myeloma or metastatic cancer who were also receiving intravenous bisphosphonates. Experts agree that patients and dentists should be made aware of the increased risk of osteonecrosis of the jaw after taking bisphosphonates. Avoiding dental procedures such as tooth extractions can minimize the risk of developing this condition.
Conclusion
Millions of patients have taken bisphosphonates to control their osteoporosis. Most side effects of these drugs are mild and manageable. The risk of more serious side effects, such as esophageal irritation and osteonecrosis of the jaw, may be significantly reduced by following accepted guidelines for taking bisphosphonates.
References
- Annals of Internal Medicine, Systematic review: bisphosphonates and osteonecrosis of the jaws; S. Woo, J. Hellstein, J Kelmar; May, 2006
Member Comments