Bisphosphonates: Uses, Side Effects, and Types

Box of stretch bands

Discover how bisphosphonates play a pivotal role in treating osteopenia and osteoporosis while learning about the potential side effects.

Disclaimer: If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Well Guide contain information from peer-reviewed research, medical societies and governmental agencies; however, these articles are not a substitute for professional medical advice, diagnosis, or treatment.

One in 2 women over 50 will break a bone due to osteoporosis, and millions of women are at risk of developing osteopenia and osteoporosis – conditions characterized by weakened bones. Understanding what leads to bone loss, how it can be diagnosed, and how to treat it is of utmost importance. Luckily, there are multiple effective pharmacological treatments that can help, the most popular of which is bisphosphonates.

Bisphosphonates are an integral component in the management of low bone mass. Understanding how these drugs work, when they are indicated and other practical considerations can help you navigate a diagnosis of osteopenia or osteoporosis with more confidence. 

In this article, we will explore the uses, side effects and different types of bisphosphonates so you can learn more about this drug and how it may benefit your bone health now or in the future.

What are bisphosphonates?

Bisphosphonates represent a class of pharmaceutical compounds designed to support bone health. This particular class of drugs is especially relevant for women who have been diagnosed with osteopenia or osteoporosis, as they are typically the first line of treatment. They are also the most commonly prescribed medication for osteopenia and osteoporosis. 

Bisphosphonates function by slowing the activity of osteoclasts, cells that help break down bone. This in turn helps to preserve bone strength (Varacallo, 2022). This medication is an effective treatment for osteopenia and osteoporosis. By helping inhibit the breakdown of bone, it can help women who have been diagnosed with low bone density reduce their risk of fractures. 

4 common bisphosphonate drugs

There are multiple bisphosphonates drugs. Each one has a unique chemical makeup and potency which helps vary the rate of onset and the degree of effect. Here are some common examples: (Varacallo, 2022; American College of Rheumatology, 2023

  1. Alendronate (Fosamax): A pill taken 1x/day or 1x/week. It was approved by the FDA in 1995 and can reduce the risk of fracture in the hip, spine and wrist by 50%
  2. Risedronate (Actonel, Atelvia): A pill that can be taken 1x/day, 1x/week or 1/month. It was approved by the FDA for the treatment of osteoporosis in 2000 and may reduce the risk of spine and hip fractures
  3. Ibandronate (Boniva): A pill or intravenous (IV) infusion. The pill is taken 1x/month and may reduce the risk of vertebral fractures. It was approved by the FDA in 2005
  4. Zoledronate (Reclast): An IV infusion that is given in the arm 1x/year. It was approved by the FDA in 2007 and can reduce the risk of spinal fractures and hip fractures by about 70% and 40%, respectively. 

How are bisphosphonates administered?

As mentioned in the examples above, there are three main ways that bisphosphonates are administered: injections, orally (pill), and IV. Multiple factors will help you and your doctor determine which is the best option for you. 

Bisphosphonates side effects

As with any other effective pharmaceutical drug, there can be side effects when taking bisphosphonates. Side effects are rare, and usually mild. However, there are some severe side effects to be aware of. 

Common side effects include: 

  • Upset stomach
  • Heartburn
  • Flu-like symptoms (specifically if taking the IV form)

Rare severe side effects include:

  • Break (fracture) in front of thigh bone (femur), called an atypical femoral fracture
  • Osteonecrosis (death of the bone) of the jaw (usually only occurs after an invasive dental procedure, or in people with cancer who are on frequent dosing of these medications) (Mayo Clinic, 2022)

Some ways to reduce the side effects of bisphosphonates include avoiding lying down after taking the medication and making sure that you take the pill with a big glass of water.

There tend to be fewer stomach side effects with injectable osteoporosis medications. Since they are not taken orally, these medications don't tend to cause an upset stomach. 

Bisphosphonates for osteoporosis

The potential of bisphosphonates to help women mitigate age-related bone loss and potentially debilitating fractures cannot be overstated. These drugs can play a pivotal role in mitigating bone loss, enhancing bone density, and reducing the risk of fractures. The value lies not only in preventing further deterioration of the quality and strength of bone, but also in creating an environment in which bone can more effectively be strengthened. 

Ultimately, this type of therapy can be a valuable part of an osteopenia or osteoporosis treatment plan. By allowing individuals to build stronger, healthier bones it enables women to lead a fuller, more active life with reduced vulnerability to fractures and associated complications.

Bisphosphonates for Osteoporosis FAQ

Which bisphosphonate is best for osteoporosis?

The best bisphosphonate for osteoporosis depends on various factors, including individual health considerations, medical history, and lifestyle. Commonly prescribed bisphosphonates include alendronate (Fosamax), risedronate (Actonel), and zoledronic acid (Reclast). However, the determination of the best option is typically made by healthcare professionals after a thorough assessment of the patient's specific needs and potential side effects.

Do bisphosphonates really help osteoporosis?

Yes, bisphosphonates have demonstrated that they are effective in the management of osteoporosis. These medications can inhibit the activity of osteoclasts, cells responsible for breaking down bone tissue. By doing so, bisphosphonates contribute to the preservation and enhancement of bone density, reducing the risk of fractures associated with osteoporosis. 

Numerous clinical studies and real-world evidence support their effectiveness in improving bone health and reducing one’s risk of fractures (Ayers, 2023; Ganesan, 2023).

Is Prolia a bisphosphonate?

No, Prolia (denosumab) is not a bisphosphonate. Prolia is a monoclonal antibody that works differently from bisphosphonates. While bisphosphonates inhibit osteoclast activity directly, Prolia targets a protein called RANKL (receptor activator of nuclear factor-kappa B ligand) to prevent the formation and activation of osteoclasts. Both bisphosphonates and Prolia aim to strengthen bones and reduce the risk of fractures, but they have distinct mechanisms of action and are prescribed based on individual patient needs and considerations (Ganesan, 2023).

join us

Get started

Join us and experience our exercise program designed by physical therapists specifically for women with osteopenia and osteoporosis.
Already have an account? Log in here
Check mark
Thank you! Your submission has been received!
We will contact you shortly.
Oops! Something went wrong while submitting the form.

Explore related exercises

No items found.


  1. Varacallo M, Seaman TJ, Jandu JS, et al. Osteopenia. StatPearls Publishing; 2023. Accessed January 18, 2023. 
  2. Bisphosphonate Therapy. American College of Rheumatology. March 2023. Accessed January 18, 2023.
  3. Osteoporosis treatment: Medication can help. Mayo Clinic. November 1, 2023. Accessed January 18, 2023.
  4. Ayers C, Kansagara D, Lazur B, Fu R, Kwon A, Harrod C. Effectiveness and Safety of Treatments to Prevent Fractures in People With Low Bone Mass or Primary Osteoporosis: A Living Systematic Review and Network Meta-analysis for the American College of Physicians. Ann Intern Med. 2023;176(2):182-195. doi:10.7326/M22-0684
  5. Ganesan K, Goyal A, Roane D. Bisphosphonate. StatPearls Publishing; 2023. Accessed January 18, 2023.

Explore related articles