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Some bisphosphonates, such as alendronate and risedronate, are taken by
mouth (orally). Others, such as pamidronate and zoledronic acid, are given
Bisphosphonates decrease the number and
activity of bone cells (osteoclasts) to reduce the breakdown of bone tissue.
Bone has a more normal structure after bisphosphonate therapy.
Bisphosphonates decrease bone
tissue breakdown. This
leads to more normal bone structure and then to less pain and less risk of
Doctors may use bisphosphonates to help
complications in people who have
Paget's disease but do not yet have symptoms. They also use bisphosphonates before
surgery to decrease the activity of Paget's disease, so there is less risk of
bleeding and complication from the surgery.
Most often, bisphosphonates are the
first medicines doctors use to treat Paget's disease and control its
Bisphosphonates slow the rate of bone tissue breakdown
and increase bone thickness in the spine and hip. This slows the progression
of the disease. Bisphosphonates can also reduce symptoms that Paget's disease
can cause, such as bone pain,
ringing in the ears, dizziness, and numbness or weakness.
Bisphosphonates may take several months to become fully
effective. Effects of bisphosphonates tend to last even after the person stops
taking the medicine. In some cases, a person may need additional courses of the
medicine to treat a return to
Reduction in laboratory
markers such as alkaline phosphatase shows that the medicine is working to
reduce the activity of Paget's disease. Some people eventually become resistant
to one medicine, so it doesn't work as well to control their symptoms. When
this happens, another bisphosphonate or another medicine may be
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
Call 911 or other emergency services right away if you have:
Call your doctor if you are taking bisphosphonates by mouth and you have:
Call your doctor if you are taking intravenous (IV) bisphosphonates and you have:
Common side effects of this medicine include:
See Drug Reference for a full list of side effects. (Drug Reference is
not available in all systems.)
Bisphosphonates are not usually recommended for people with severe kidney disease. Your doctor will test your kidney function before prescribing bisphosphonates, especially if you are considering zoledronic acid (Reclast).
If you are considering a bisphosphonate that is taken by mouth, be sure to tell your doctor if you have ever had serious heartburn or problems with your esophagus (the tube that connects your throat to your stomach).
For the best results
and to reduce the risk of irritation to your
esophagus if you take bisphosphonates by mouth:
Tell your doctor if you notice any new or increasing problems with swallowing. Problems could include feeling pain when you swallow or feeling like you have a lump or sore in your throat.
Tell your doctor if you notice pain in your thigh or groin. Some research suggests that taking bisphosphonates for a long time may slightly increase the risk of breaking the thigh bone.
Serious problems with bone healing, particularly after
dental surgery, have been found in some people who take bisphosphonates.2 If you are taking bisphosphonates and need dental surgery,
talk with your doctor.
often used in cycles. They nearly always make Paget's disease
inactive, sometimes for years or decades. But in some
people Paget's disease becomes
active again. You use bisphosphonates until pain
decreases and lab tests show normal results. Then you take a break from the
medicine for about 3 months or until lab tests show that Paget's disease is
If you are taking bisphosphonates, your doctor may also recommend that you take
calcium and vitamin D supplements. But
calcium supplements may interfere with your body's
ability to absorb bisphosphonates, so take your bisphosphonate and your calcium supplement at least 30 minutes apart.
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
Complete the new medication information form (PDF)new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Lane N (2009). Paget's disease of bone
section of Metabolic bone diseases. In GS Firestein et al., eds.,
Kelley's Textbook of Rheumatology, 8th ed., vol. 2, pp.
1593–1595. Philadelphia: Saunders Elsevier.
Woo S-B, et al. (2006). Systematic review: Bisphosphonates and osteonecrosis of the jaw. Annals of Internal Medicine, 144(10): 753–761.
August 30, 2013
Anne C. Poinier, MD - Internal Medicine & Jennifer Hone, MD - Endocrinology, Diabetes and Metabolism
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