Bisphosphonates slow down loss of bone cells but do not speed up bone formation. Which bisphosphonate you use depends upon your preference and potential cost issues. Intravenous pamidronate (90 mg over at least 2 hours) or zoledronic acid (4 mg over at least 15 minutes) every 3 to 4 weeks is recommended by the guidelines of the American Society of Clinical Oncology (ASCO) if you have multiple myeloma, either with lytic destruction of bone or osteoporotic spine compression fracture.
Let’s look at each of the categories in a little more depth. If you were diagnosed with osteoporosis, your doctor will most likely recommend one of the bisphosphonates like alendronate, ibandronate, risedronate or zoledronic acid. These drugs do not speed up new bone formation. They act by slowing down bone loss. There are several to choose from and the main factors in choosing between them are how the medicine is taken and how often.
Most bisphosphonates are pills. Some are taken once a week or once a month. Many people prefer pills because they are easy to take. However, these pills can be hard on the esophagus, that’s the tube that goes from your throat to your stomach. So when you take these pills, it is important to take on an empty stomach with a glass of water. Then for the next 30 to 60 minutes you must not eat or drink or lie down to lessen the risk of the medicine washing back to your esophagus. People who are not able to do this or who have had stomach ulcers or esophagus problems may not be well-suited to the pill form of bisphosphonates. Bisphosphonates can also be given through your vein by intravenous. These are given at the doctor’s office. These forms of the drug only has to be given once every few months or even once a year.
Many people have no side effects from bisphosphonates. Others may report stomach upset and heartburn. And some may experience bone pain. There is some other rare or serious cases that have happened in some cases and are therefore risks. One is damage to the esophagus. Another is where the bone in the jaw breaks down. Another a break or a fracture in the thigh bone happens. Although these medicines prevent the most usual kinds of fractures they can cause these other fractures called atypical because unlike common breaks they happen in a less common spot in the thigh and they can happen without a major stress or injury to the bone. These risks are rare and mostly happen in women who have used the medicine for a long time or in high doses.
Bisphosphonates should be taken on an empty stomach with a glass of water. Do not take any food or drink and avoid lying down for 30-60 minutes after taking the medicine. Also take adequate calcium and vitamin D to avoid developing low calcium levels in your body.
Reflux esophagitis, ulcers, hypocalcaemia, osteonecrosis of the jaw, renal insufficiency, atypical femur fracture (AFF)
Because osteoporosis medicines are powerful, they also have the potential for unwanted side effects. And some of these can be serious. Be sure to read the drug information sheets that the pharmacists give you so you can be alert to any unwanted side-effects and report them to your doctor.
Patient: Doctor, I have some questions about my medications.
Doctor: Good, good, lets talk about it.
Patient: Well I brought this but I did want to ask about….
Medications may need to be adjusted over time. You won’t be able to feel how well your medication is working on your bone density so your doctor needs to see you regularly. It is important to keep all your doctor and clinic appointments.
Remember the goal of osteoporosis treatment is to prevent further loss of bone mass and potential fractures.