Bisphosphonate Drugs – Side Effects of Bisphosphonate Drugs

History of Bisphosphonate Drugs

Bisphosphonates have been used since the middle of the 19th century when they were employed for corrosion prevention and washing powders in the textile, fertilizer and oil industries. Their development as a major class of drugs for the treatment of bone disease began only about 30 years ago when scientists discovered bisphosphonates have the marked ability to inhibit the breakdown of bones.

Today bisphosphonates are considered to be almost a miracle osteoporosis treatment drug. This is a common condition of post-menopausal women who experience a decrease in bone mass and density, causing bones to become fragile and fracture easily. Bone cancer patients and those with Paget’s disease are also frequently prescribed bisphosphonates.

The National Osteoporosis Foundation estimates osteoporosis causes more than 1.5 million fractures each year, including more than 300,000 hip fractures and about 700,000 vertebral fractures, 250,000 wrist fractures and 300,000 fractures at other sites. Numerous studies such as a report published by the Department of Health and Human Services have clearly demonstrated the use of oral bisphosphonates reduces bone loss, increases bone density and reduces the risk of fractures.

How Bisphosphonate Drugs Work

Bisphosphonates affect the two main cell groups in the bone. These are called osteoblasts, which make bone material, and osteoclasts, which break down the bone. It is believed bisphosphonates shorten the lifespan of the cells that break down bones, while reinforcing the bone-making osteoblasts. This results in a very positive outcome for preventing common fractures such as in the spine and hip.

Evidence That Bisphosphonate Drugs are Working

A patient will not feel bisphosphonates working in his or her body, but progress can be monitored with a bone mineral density (BMD) test commonly called a Dexa scan. A Dexa scan is far more accurate than a regular X-ray or CAT scan and uses much less radiation. Increases in bone mass can be seen in as little as three months after therapy has started, but your doctor will recommend the frequency needed for any ongoing BMD tests.

Interactions With Other Drugs

It is always very important to tell your doctor about any other drugs you are taking, whether they are prescribed, over the counter or herbal. Sometimes they can prevent the full effectiveness of bisphosphonates or may cause negative side effects. Some examples of drugs that may not react well with bisphosphonates are corticosteroids such as prednisone and cancer chemotherapy. Also, aspirin or nonsteroid anti-inflammatory drugs such as ibuprofen or naproxen could cause stomach irritation or ulcers. However low doses of aspirin to help prevent heart attacks or strokes should cause no problems.

Side Effects of Bisphosphonate Drugs

You should immediately notify your doctor if you experience symptoms such as:

  • Heartburn
  • Difficult or painful swallowing
  • Chest pain
  • Bone, joint or muscle pain
  • Mental or mood changes
  • Stomach pain
  • Fever or sore throat
  • Stomach upset or diarrhea

If you have a known disorder of the esophagus, you may not be able to take bisphosphonates. It is rare to have a very serious allergic reaction to these drugs, but you should seek medical attention if you experience a rash, itching or swelling, severe dizziness, or trouble breathing.

You should also be aware that after an invasive dental procedure such as having a tooth pulled or implants installed, a relatively small number of people who take bisphosphonates are experiencing a rare condition known as osteonecrosis of the jaw (ONJ), also known as jaw death. These patients have severe infections with facial numbness, gum swelling, drainage and little or no gum healing, leaving the jaw bone exposed. This is turn can cause tooth loss and other disfigurement. And because bisphosphonantes have a half life of over 10 years it remains in the body after one stops taking them, still exposing the dental patient to an increased risk for osteonecrosis. Less invasive dental procedures such as filling cavities and placing crowns do not appear to trigger ONJ. This condition is seen more frequently in bone cancer patients who are taking large quantities of these drugs, but it is always a good idea to have any invasive dental procedures taken care of before starting bisphosphonate treatment.

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  • Boniva Side Effects

Alternatives to Bisphosphonates

If a patient is not responding well to bisphosphonates or is experiencing adverse side effects, other choices for treating osteoporosis include hormone replacement therapy (HRT) or Raloxifene (Evista). Doctors are now discouraging long-term use of hormone replacement therapy due to a 2002 study by the Women’s Health Initiative that found an increased risk of invasive breast cancer, heart disease, stroke and blood clots among users of estrogen plus progestin. A week later, a National Cancer Institute study of 44,000 women found an increased risk of ovarian cancer in those who took estrogen-only HRT.

For those who do not have a history of blood clots such as deep venous thrombosis, pulmonary embolism, or retinal vein thrombosis, an alternative to bisphosphonates may be Raloxifene, with the brand name Evista. It has the added benefit of possibly lowering the chance of getting invasive breast cancer in women after menopause.

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