PATIENT INFORMATION ON
What are Bisphosphonates?
What benefit can you expect from
Bisphosphonates are medicines used to treat
bone diseases such as osteoporosis and Paget’s
Since osteoporosis doesn’t usually have any
disease. Alendronate (Fosamax®, Fosamax
symptoms such as pain, you will not ‘feel’ any
immediate benefit from your treatment with
prescribed bisphosphonates in Australia.
If used for Paget’s disease, bone pain may
lessen with time. Your doctor will explain the
causes bones to become fragile and brittle.
This means bones can break more easily (fracture), which is painful and restricts a
You may be asked to have tests to check the
person’s ability to carry out their normal daily
tasks. In osteoporosis, bisphosphonates reduce
example, a bone mineral density test is usually
done after one to two years of treatment. This is a type of x-ray, which involves a very small
In Paget’s disease, the formation of abnormal
amount of radiation. Sometimes tests of urine
or blood are used to measure the effects of
treatment on bone formation and breakdown.
How are Bisphosphonates taken?
How do they work?
Bisphosphonates come as tablets, which are
Bone is constantly changing, with old bone
taken by mouth. They can also be given by
breaking down and new bone being formed to
injection (see separate information sheet).
take its place. This usually happens in a balanced way.
To reduce side effects and to make sure the
tablets work properly, you must
If the cycle becomes unbalanced, bone is
when your stomach is empty and with a full
broken down faster than it is replaced. This
glass of water.
It is best to take the tablets first
Bisphosphonates are medicine that slow or
You then need to wait for at least half an hour
stop the bone breaking down. As a result,
before eating or taking any other medicines.
bone density may increase over time so fewer
You should not lie down for 30 minutes after
taking these tablets.
What is the dosage?
Tablets come in different strengths. The dose
will depend on the type of bisphosphonate
• Headache and/or dizziness may occur.
being taken and the condition for which it is
• Rarely bisphosphonates have been found to
cause mouth ulcers, aching muscles, joints
For osteoporosis, the medicines are taken as a
and/or bones and swelling of joints. These
single tablet once a week or once a month for a
Less common or rare side effects:
For Paget’s disease they are usually taken daily
• A potentially serious but very rare side
for a limited period. Unless otherwise directed
by a doctor, always follow the instructions
Are other medicines taken with
usually occurs after dental work which does not heal properly. For most patients
who are taking oral bisphosphonates, the
It is safe to use most other medicines when you
benefits of these medicines outweigh the
are taking bisphosphonates. (However, it is
potential risk of ONJ. As a precaution, it is
important not to take other medicines within
30 minutes of taking bisphosphonate tablets).
Your doctor will usually advise you to be on
extractions be performed before starting
calcium and vitamin D supplements as well as
• Bisphosphonates can cause skin reactions
such as rash or redness of the skin, which is
How long is the treatment continued?
bisphosphonates is usually given for at least
• Blurred vision, pain or redness in the eyes
five years. Your doctor will review your
For Paget’s disease, the treatment may be given for a shorter period of time.
What precautions are necessary?
Care of your teeth and mouth:
Are there any side effects?
• Before starting bisphosphonate treatment,
Most people who take bisphosphonate tablets
have your teeth checked by your dentist. If
do not experience side effects. Below are some
surgery on the jawbone is necessary, this
side effects that you might experience with
experience any problems. A reduction in dose
• While taking a bisphosphonate, maintain
or change to another medication may minimise
good oral hygiene and have regular dental
the side effects so that you can continue to
• Monitoring blood tests is not usually
Tell your doctor if you experience any
required for people taking bisphosphonates
situations these may be needed. In Paget’s
Most common side effects:
disease your doctor may ask you to have a
stomach resulting in stomach pain, increase
• Some bisphosphonates are packaged in
• You should tell your doctor about all
medicines you are taking or plan to take.
• Ask your doctor to explain exactly what
medicine you are taking and how to take it
You should tell your doctor about all
The risk of side effects from the low doses of aspirin used to prevent heart attack and
medicines you are taking or plan to take.
strokes is not increased when taken with
This includes over the counter or
herbal/naturopathic medicines. You should
also mention your treatment when you see
• Nonsteroidal anti-inflammatories (NSAIDs)
other health professionals.
may also cause inflammation of the oesophagus and stomach so your doctor
may advise you not to take NSAIDs if you are taking a bisphosphonate.
• Because these medicines can increase your
risk of stomach inflammation, you should
• Methotrexate can be taken safely with
avoid heavy alcohol use while taking them.
• The simple pain reliever paracetamol, and
Pregnancy and breastfeeding
and Panadeine Forte®, can be used while
Bisphosphonates are not recommended to be taken during pregnancy or during
taking bisphosphonates provided you take
breastfeeding. If you are planning a family
• The absorption of bisphosphonates from
this with your doctor as soon as possible.
the stomach can be reduced by over the counter antacids such as Gaviscon, Mylanta and Rennies, and by prescribed medicines such as omeprazole.
All patients taking Bisphosphonates
Your doctor’s contact details:
should be seen regularly by a specialist
who prescribed the medicine to optimise
treatment and to minimise any potential
If you have any questions or concerns
write them down and discuss them with
REMEMBER – Keep all medicines out of
reach of children
The information in this sheet has been obtained from various sources and has been reviewed by the Australian Rheumatology Association. It
is intended as an educational aid and does not cover all possible uses, actions, precautions, side effects, or interactions of the medicines
mentioned. This information is not intended as medical advice for individual problems nor for making an individual assessment of the risks
and benefits of taking a particular medicine. It can be reproduced in its entirety but cannot be altered without permission from the ARA.
Australian Rheumatology Association
Bisphosphonates (Tablets) First edition August 2007 for revision November 2007
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