Osteoporosis is a condition that leads to weakened bones, making them more prone to breaks and fractures. One treatment option for osteoporosis is bisphosphonate medications.

Osteoporosis develops when the structure and strength of bone change or when bone mineral density and bone mass decrease.

According to the Centers for Disease Control and Prevention (CDC), in 2010, osteoporosis affected nearly 10.2 million people ages 50 and over in the United States. In addition, nearly 43.3 million people had low bone density, which increases the risk of developing osteoporosis.

This article explores bisphosphonates, including what they are, their efficacy, and their potential side effects. It also discusses other treatment options for osteoporosis and when someone should speak with a doctor.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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Bisphosphonates are a group of medications that doctors use to treat osteoporosis and other conditions affecting the bones, such as Paget’s disease. They work by inhibiting bone resorption, which is the bodily process of breaking down and absorbing old bone tissue as part of the bone growth cycle.

There are two types of bisphosphonates: nitrogen-containing and non-nitrogen-containing.

Both types work by attaching to binding sites on the bone, particularly in areas with active resorption. As bone-resorbing cells, or osteoclasts, begin to resorb the bone, it releases the bisphosphonates embedded in it and impairs the cells’ ability to continue the resorption process.

Nitrogen-containing bisphosphonates work by inhibiting an enzyme called farnesyl pyrophosphate synthase, which helps osteoclasts attach to the bone. In this way, nitrogen-containing bisphosphonates cause the osteoclasts to detach from the bone surface, thus inhibiting bone resorption.

Non-nitrogen-containing bisphosphonates undergo metabolism within the osteoclast, forming a non-functional molecule that competes with adenosine triphosphate, an energy source for the osteoclast. This causes the osteoclast to die, which leads to a decrease in bone loss.

Nitrogen-containing bisphosphonates have a higher success rate and fewer negative effects. As a result, healthcare professionals no longer broadly use non-nitrogen-containing bisphosphonates.


There are different types of bisphosphonates. Some common examples are:

Learn more about osteoporosis medications and their side effects.

Research suggests that all bisphosphonates help improve bone mineral density in postmenopausal females with osteoporosis. More specifically:

  • Alendronate may reduce the risk of vertebral (spine) fractures by about 50% and hip fractures and other non-vertebral fractures by about 30%.
  • Ibandronate may reduce vertebral fractures by about 50%.
  • Risedronate may reduce vertebral and non-vertebral fractures by about 40%.
  • Zoledronic acid may reduce vertebral fracture risk by about 70% and hip fractures and other non-vertebral fractures by about 35%.

A person should speak with their doctor about which type of bisphosphonate may work best for them.

Read more about postmenopausal osteoporosis.

Research suggests that people generally tolerate bisphosphonates well and that most side effects are not severe. However, in rare cases, people have reported more severe side effects.

Potential side effects include:

Another potential side effect is osteonecrosis of the jaw. Osteonecrosis involves a disruption in blood flow to part of a bone and can lead to the death of bone tissue. The bone can eventually break down, and the joint will collapse.

Osteonecrosis of the jaw involves a disruption of blood flow to the jaw due to exposed jawbone. This results in tissue death in that area.

If a person receives bisphosphonates through an IV infusion, they may experience flu-like symptoms and muscle aches, joint pain, and headaches within 1–3 days of the infusion.

In addition to bisphosphonates, there are other management options for osteoporosis, such as:

  • exercise
  • calcium and vitamin D supplements
  • management of the risk of falls at home, which may involve assessing the home for hazards and wearing appropriate footwear
  • selective estrogen receptor modulators, which are medications that help maintain bone density and reduce the risk of fracture similarly to the hormone estrogen
  • parathyroid hormone treatments, which help stimulate the cells that create new bone
  • hormone replacement therapy for those who are going through menopause
  • biologic medications such as denosumab and romosozumab

People should speak with a healthcare professional who can identify which treatments may work best on an individual basis.

Learn more about parathyroid hormone and osteoporosis.

Individuals living with osteoporosis should speak with a healthcare professional if they experience pain or discomfort that may be related to the condition. Older people should also speak with a doctor about their potential risk of developing osteoporosis and any steps they can take to help prevent it.

Additionally, a person should contact a healthcare professional if they experience any negative effects while taking bisphosphonates. A doctor may be able to recommend alternative treatments such as biologic medications or a different type of bisphosphonate medication.

Healthcare professionals may also be able to provide additional advice to help someone manage their osteoporosis, such as reducing the risk of falls in the home and maintaining a healthy lifestyle alongside taking medication.

Osteoporosis develops when a person loses bone mineral density and bone mass. This can lead to fragile bones that are more prone to breaks and fractures.

Bisphosphonates are a group of medications that healthcare professionals prescribe to treat osteoporosis. They work by impairing bone resorption. Research suggests that they are effective, but they can cause side effects.

There are alternative treatments for osteoporosis, such as vitamin D and calcium supplements, exercise, and other medications. A person should speak with a healthcare professional about which treatments may work best for them.