Yes, for most people with osteoporosis or high fracture risk, the benefits of bisphosphonates in preventing fractures generally outweigh the risks, though rare but serious side effects like osteonecrosis of the jaw (ONJ) and atypical femur fractures can occur, especially with long-term use, leading to recommendations for periodic "drug holidays". The decision depends on individual fracture risk, and a doctor helps weigh these pros and cons, with newer evidence even suggesting benefits in reduced mortality.
Bisphosphonates can reduce the risk of osteoporotic fracture in postmenopausal women [1], [2]. Proper use of these agents is associated with few adverse effects. Generic oral bisphosphonates have recently become available reducing the cost of treatment.
Side effects for all the bisphosphonates (alendronate, ibandronate, risedronate and zoledronic acid) may include bone, joint or muscle pain. Side effects of the oral tablets may include nausea, difficulty swallowing, heartburn, irritation of the esophagus (tube connecting the throat to the stomach) and gastric ulcer.
Once diagnosed, patients who fail to comply with treatment for osteoporosis are known to increase their risk of future fracture regardless of the efficacy of the treatment prescribed.
The pooled probability of ONJ toxicity in the bisphosphonates group was 2%. Conclusions: Bisphosphonates were significantly associated with influenza-like illness, fatigue, fever, dyspepsia, anorexia, and urinary tract infection. Furthermore, bisphosphonates increase the risk of ONJ toxicity.
Recommendations and safety
BPs are recommended as a first line treatment for women with post-menopausal osteoporosis, in the absence of contraindications. Two more serious adverse events, atypical subtrochanteric fractures and osteonecrosis of the jaw, have been associated with bisphosphonates.
You may be more likely to have recurrent UTIs if you have: A thin and dry vaginal lining (vaginal atrophy), which happens with menopause or many treatments for certain cancers, like breast cancer. Cysts in your urethra or urinary bladder that trap and hold pee and bacteria (diverticula)
Can osteoporosis medicines hurt your bones? A very rare complication of bisphosphonates and denosumab is a break or crack in the middle of the thighbone. This injury, known as atypical femoral fracture, can cause pain in the thigh or groin that begins subtly and may gradually worsen.
Biological medicines that can be used to treat osteoporosis include denosumab and romosozumab. They may be recommended if you cannot take other medicines such as bisphosphonates, or if you have severe osteoporosis.
Serum calcium, vitamin D, and renal function require baseline monitoring before initiating bisphosphonates. In patients with calcium and/or vitamin D deficiency, the recommendation is to correct the deficiency before starting bisphosphonates.
Clinical studies suggest an association between bisphosphonate use and new-onset atrial fibrillation (AF). Intravenous bisphosphonates more potently increase the release of inflammatory cytokines than do oral bisphosphonates; thus, the risk of developing AF may be greater with intravenous preparations.
Weight-bearing aerobic activities
Examples include walking, dancing, low-impact aerobics, elliptical training machines, stair climbing and gardening. These types of exercise work directly on bones in the legs, hips and lower spine to slow bone loss. They also improve blood flow and are good for the heart.
Drug or pill-induced esophagitis is esophageal mucosal injury caused by the medications and usually refers to a direct toxic effect on esophageal mucosa by the culprit medication. Common symptoms include retrosternal pain, dysphagia, or odynophagia.
Ideally, your dentist should carry out a dental assessment before you start your bisphosphonate treatment so you can have any dental or surgical treatment beforehand and avoid the possibility of complications.
Both medications can cause serious side effects like jaw problems and low calcium levels, but Reclast (zoledronic acid) also carries a risk of kidney damage, especially in those with pre-existing kidney issues.
EVENITY is a one-of-a-kind osteoporosis treatment—the first and only one that works both ways by building new bone and helping to slow bone loss.
Regular exercise is essential. Adults aged 19 to 64 should do at least 2 hours and 30 minutes of moderate-intensity aerobic activity, such as cycling or fast walking, every week. Weight-bearing exercise and resistance exercise are particularly important for improving bone density and helping to prevent osteoporosis.
Add calcium to your diet.
For adults 19 to 50 and men 51 to 70, the recommended dietary allowance (RDA) is 1,000 milligrams of calcium a day. The recommendation increases to 1,200 milligrams a day for women 51 and older and for men 71 and older. Look for calcium in dairy products, almonds, broccoli, kale and tofu.
There are certain aspects of lifestyle which can be used to prevent osteoporosis. Exercise, and in particular lifting weights helps maintain and strengthen bones. Ensuring you get a balanced diet, including enough vitamin D, vitamin K, and calcium are important for avoiding bone deterioration as you age.
The seven worst foods for osteoporosis include excessive salt, caffeine, soft drinks, alcohol, high-protein diets, processed foods, and foods high in oxalates. Limiting these foods can help support bone health and reduce the risk of osteoporosis.
Parathyroid Hormone (PTH) Analog & PTH-Related Protein (PTHrP) Analog - These increase bone mass and are prescribed for those with severe osteoporosis or high fracture risk. Sclerostin Inhibitor - Blocks a protein to increase new bone formation and slow bone loss in severe osteoporosis cases.
Osteoporosis–low bone mineral density–has the potential to be overdiagnosed, since according to its definition, many otherwise healthy people are labelled with a “disease” because they are at risk for future fracture [4].
Frequent infections are usually treated with a lower dose of antibiotics taken for a longer period of time. Some patients may be advised to use self-directed antibiotic therapy, referring to the use of antibiotics at the first sign of an infection.
Nseir et al found that recurrent UTIs in premenopausal women are associated with vitamin D deficiency.
Follow these tips to lower your risk of a UTI with little or no potential negative side effects: