More Evidence Confirms Bisphosphonates (e.g. Fosamax, Boniva) are Not Your Bones’ Best Friends

Research / October 31, 2011

Author: Lara Pizzorno, MDIV, MA, LMT

Lara Pizzorno is the author of “Your Bones: How You Can Prevent Osteoporosis and Have Strong Bones for Life – Naturally” and a member of the American Medical Writers Association with 29 years of experience specializing in bone health . Lara is the Editor of Longevity Medicine Review ( as well as a Senior Medical Editor for SaluGenecists Inc., and Integrative Medicine Advisors, LLC  

My book, Your Bones, starts out with 30 pages’ worth of reasons why taking a bisphosphonate should be your last choice for healthy bones. Yes, there truly are that many reasons why relying on a bisphosphonate, like Fosamax, Boniva or Reclast, is more likely to harm than help your bones.

Since Your Bones, which includes more than 400 citations to the peer-reviewed medical research, was published last May, even more damning evidence has surfaced confirming that your risk of an osteoporotic fracture is not going to be lessened – but, in fact, may be increased, by taking these expensive and dangerous drugs. Here’s a quick summary of recent highpoints:

Bisphosphonates not helpful, may harm, women with breast cancer

Cancer cells stimulate osteoblasts (the cells that break down old bone), thus increasing the rate at which bone is lost. Plus, when old bone is broken down, bone-derived growth factors are released that nearby cancer cells could possibly co-opt for their own growth.  So, it was hypothesized that giving women with early stage breast cancer a bisphosphonate along with chemo might help preserve their bone mass, reduce their likelihood of dying and, if treatment were successful, of having a recurrence of their cancer.

Unfortunately, this hope has not panned out.

Results of a large, randomized trial involving 3,360 women with early stage breast cancer, published in the New England Journal of Medicine, October 13, 2011, found that adding zoledronic acid (an IV-delivered bisphosphonate, trade names Reclast, Aclasta) to adjuvant chemotherapy in patients with early-stage breast cancer not only does not improve rates of recurrence or survival, but can cause osteonecrosis of the jaw (ONJ), death of the jawbone. Link to the paper on NEJM:

Fosamax continues to suppress normal bone rebuilding in the spine for at least 1 year after stopping treatment

In this study, published October 8, 2011, in the journal Osteoporosis International, postmenopausal women who had taken Fosamax for at least 3 years discontinued treatment and were checked six months and one year later. Bone remodeling in their lumbar spines (lower back) was still suppressed after one year, and their spinal bone mineral density was significantly decreased.

What does this mean? An increased risk for a spinal fracture. How long will it take before the lumbar spine begins to rebuild in these women? No one knows. The study authors’ conclusion: “further clinical studies are required to fully evaluate the persistence of BP [bisphosphonate] treatment.” My conclusion: you have to be nuts to take these drugs! Link to the abstract on PubMed:


FDA warning to doctors: do not use the bisphosphonate, zoledronic acid (Reclast, Aclasta) in persons with kidney disease

After cases of acute renal failure requiring dialysis or having a fatal outcome (PR-speak for “the patient died”) following Reclast use were reported to the FDA, they said that labeling for this bisphosphonate had to be revised to state:

“Reclast is contraindicated in patients with creatinine clearance less than 35 mL/min or in patients with evidence of acute renal impairment.”

The creatinine clearance rate is the rate at which a person’s kidneys are able to filter out or clear creatinine from the blood passing through them and is considered an accurate indication of how well the kidneys are able to do their filtering job overall. A creatine clearance rate of less than 35 mL/min indicates that clearance is too slow – in other words, that kidney function is impaired. Many drugs, including the bisphosphonates, are eliminated through the kidneys.

The revised label also tells healthcare professionals to be sure to screen people before administering Reclast to ensure they have identified “at-risk patients”. So, who is “at risk” of renal failure from Reclast besides folks with a creatinine clearance less than 35 mL/min? Anyone using kidney-damaging (nephrotoxic) drugs at the time Reclast is given. Whoa! Many commonly taken drugs are nephrotoxic, including non-steriodal anti-inflammatory drugs (e.g., acetaminophen [Tylenol], ibuprofen [Advil, Motrin], aspirin), and drugs taken for high blood pressure (e.g., ACE inhibitors, Angiotensin Receptor Blockers, diuretics). “At risk” folks also include people who are dehydrated either before or after Reclast is given. Among older individuals, in whom the sense of thirst is often diminished, dehydration is all too common. (or if you prefer, here is the full link:

FDA Advisory Committee Bulletin: Limit Bisphosphonate Use to Maximum of 3 Years – Longer Use May Cause Atypical Femur Fractures, ONJ, Esophageal Cancer

On September 9, 2011, a joint FDA advisory committee meeting of The Advisory Committee for Reproductive Health Drugs, and the Drug Safety and Risk Management Advisory Committee, was held in response to increasing reports of adverse events —  including “atypical femur fractures, osteonecrosis of the jaw and esophageal cancer” — caused by bisphosphonates. The question raised was, should the FDA change the label on all the bisphosphonates to say that these drugs should not be used long term?

The panel heard from women who were taking bisphosphonates to prevent osteoporosis when suddenly, during normal activities, their femurs (thigh bones) – very painfully – broke. One woman was standing on a subway train. When it came to a halt and her weight transferred onto one leg, its femur snapped, and she collapsed. Other women related similar stories — a teacher reaching for something in class, a grandmother taking a big step towards her grandchild, a woman just walking outside her front door to pick up the morning newspaper. In each case, despite the complete absence of any trauma or excessive stress, their femurs simply snapped.

The panel was also concerned with bisphosphonates’ link to “deterioration of the jawbone”. In 2005, the FDA added a warning on bisphosphonates about osteonecrosis of the jaw, a supposedly rare disease. Data presented to the panel, however, indicate that risk for osteonecrosis of the jaw is not so inconsequential, nor so rare, and increases significantly after four years or more of bisphosphonate use. I explain why the jaw is especially susceptible to harm from bisphosphonates in Your Bones.

Other data suggest a link to long-term use of bisphosphonates and esophageal cancer. A study published in 2009 in the New England Journal of Medicine used data from FDA’s Adverse Event Reporting System to identify and describe 23 patients taking Fosamax who were diagnosed with esophageal cancer.

After hearing all this, what do you think the committee did? The majority (17-6) voted to endorse a label change.

To quote Sonia Hernandez Diaz, MD, associate professor of epidemiology at Harvard School of Public Health: “What we’re talking about today is using these drugs for more than three years, and I’m not convinced at all that there are any good data that, even for subgroups of patients, they should be continued [past three years].” (Link =

Given that, in addition to their long list of adverse effects (you can read about all of them in Your Bones, but here, I have to at least mention they also include increased risk of atrial fibrillation [an erratic heartbeat] and therefore of a heart attack) all that bisphosphonates do is poison osteoclasts. Thus they prevent normal bone remodeling and leave users with increasingly brittle bones. Personally, I cannot see why anyone should take these drugs for one second, much less three years.

What should you be doing to maintain or restore healthy bones?

For detailed recommendations, read Your Bones, but the bottom line is:

Eat real food: not the processed stuff in boxes in the center aisles of the grocery, but the whole fresh foods in the refrigerator cases along the grocery’s perimeter. Eat lots of mineral and vitamin K-rich green leafy vegetables, magnesium-rich whole grains, omega-3 and vitamin D- rich wild caught Alaskan salmon, omega-3-rich eggs from uncaged chickens, calcium-rich organic yogurt and cottage cheese, anti-inflammatory blueberries for dessert.

Enjoy weight-bearing exercises: Dance, sign up for a Zumba class, walk—fast, exert yourself! Lift weights — try SuperSlow, a weight lifting protocol designed to combat osteoporosis, or the BodyPump class at your gym.

And take the right supplements! Your body cannot rebuild and maintain healthy bones unless you provide it with all the necessary ingredients. For a full discussion of exactly what your bones need and how much, read Your Bones. (I apologize for the shameless promotion here, but just cannot give you all the details in a blog.) Bottom line: our eat-on-the-run, vitamin-and-mineral-poor diets, combined with the fact that conventionally grown produce just does not supply the same level of many nutrients as food grown 50 years ago (or today, if organic) translates to the fact that we need to supplement. Supplements provide nutrient insurance. Fortunately, in relation to your bones, AlgaeCal’s got you totally covered.

My prescription for healthy bones: Eat well, exercise and take AlgaeCal. That’s what I do.

Donna Villafranca

Any information about using SottoPelle, not only for hormone therapy, but, also for poor bone density

Isy Mc Donald

I stopped taking Actonal 15 months ago being on Fosamax and then Actonal for 12 years. I had a Bone Density test 3 weeks ago and instead of the steady decline that has been showing every 2 years, I had a 2% improvement. Not large admitedly but encouraging. My GP admitted that he hadn’t been happy when I stopped, but now he is going to look into it more closely.


I thought thing like cottage cheese and yogurt were not good for your bones because they are mad with cow’s milk, which is acidic, and robs the bones of calcium? This is what Marilyn Glenville says, anyway, and she is considered a leading expert in osteoporosis.

Lara Pizzorno

Hi Julie,
I’m so glad you asked about this. It can certainly be confusing. It is true that a diet that results in your body having a more acidic pH – for example, the Standard American Diet, which is excessively high in protein — greatly increases the amount of calcium released from our bones and excreted in urine. But the issue is not dairy products, per se, but consuming too much protein–of any kind–in your diet. A diet too high in any type of protein (typically this means animal protein because animal foods are the most concentrated sources of protein) is going to result in an acidic body chemistry and will leach calcium from your bones.
If you are not allergic to milk protein, then dairy foods can make a healthful, bone-building contribution to your diet. Not only do dairy products provide calcium, but they also contain whey, and some very exciting new research is showing that the basic protein fraction of whey, which is called milk basic protein (MBP), contains several components capable of promoting bone formation and inhibiting bone resorption! Dairy foods like cottage cheese and yogurt may also contain beneficial friendly bacteria, like lactobacillus and bifidobacteria, that greatly support our intestinal health and improve our ability to absorb nutrients, while also producing a number of health-protective compounds for us. Check the label on the cottage cheese and yogurt you buy to make sure it contains “active cultures” of these friendly pro-biotics.
Just remember, you need to be sure your diet overall is not supplying too much protein. You will need to determine how much protein YOU (not some mythical average person) should be getting, so you make sure to get enough, but not too much. How much protein YOU need varies depending upon your height and ideal weight (which may not be what you weigh at this moment, but is what you should ideally weigh). I explain in detail how to determine both how much protein your diet is providing and how much YOU actually need in Your Bones pp. 58-64. It is worth the few minutes of effort required to figure this out because research has shown that when women with osteoporosis consumed excessive amounts of protein, the amount of calcium they lost in their urine doubled! Most of us need somewhere between 40 and 50 grams of protein daily. Most Americans get between 91 and 113 grams daily!
So, if you are not allergic to cow’s milk and enjoy dairy foods like cottage cheese and yogurt, by all means, include these foods in your bone-building diet. Just be sure the amount of protein in your diet–overall–is neither too high, nor too low. A diet too low in protein has been associated with reduced absorption of calcium from the intestines, so can also promote bone loss.

Jeanne Whitmee

I was prescribed alentonic acid for osteoporosis after breaking my arm which was followed by a DEXA scan. I began taking the tablets but twelve hours after taking I suffered horrendous nose bleeds. During the last one, which lasted for forty-five minutes I was almost choking on blood, which poured from nose, mouth and even my eyes. I had to call NHS Direct for assistance. My doctor simply changed the prescription to a different bisphosphonate which I refused to take. Later a consultant simply refused to believe that the bleeds could have been caused by the tablets.
Has anyone else suffered similar side effects?


Hi, I have just read your horrific story with Bisopphonates. I haven’t had that experience, thankfully, but I wouldn’t take them either. I have broken a hip and leg in the past 2 and a half years, and go into hospital for surgery on my knee, this wednesday, because things still aren’t right. So, I just don’t seem to get free of crutches. However, from all I have read about alendronic acid, I wouldn’t touch it with a barge poll, even though they say my bones are like twigs, and I am only 50.
As well as good supplements and diet, I drink a glass of prune juice every day. This is supposed to be bone strengthening.
I am sorry to hear of your experience, and hope this helps a bit, anyway.

Lara Pizzorno

Hi Julie,

If you have not read my book, Your Bones, please consider doing so. I am absolutely positive that once you identify what is causing your bone loss, it can be reversed. I lay out in the book all the possible contributing factors to bone loss – how to figure out which might be affecting you – and what to do about it. Also everything your bones need, how to figure out how much of each of these nutrients YOU need. The book is very inexpensive – it’s published by Praktikos which is a non-profit, so cost has been kept quite low. It’s available on Amazon.

If you have some ideas as to what’s going on with your bones, please write me and I will be happy to try to help you figure it out.

Some common offenders are lack of adequate vitamin D (have you had a blood test run to check your vitamin D levels?), lack of adequate vitamin K2 (which helps your body deposit calcium in bone and keeps it out of your arteries), digestive issues that compromise nutrient absorption (you might be sensitive to gluten or could have other food allergies or helicobacter pylori infection or simply not be making enough stomach acid to digest your food properly – or many other things, too much to write here, but I lay these all out in the book).

Also, given your recent fractures and young age, I think it would be very helpful for you to have your hormone levels all checked (you’ll need to have a 24-Hour Urine test run by a physician knowledgeable about bio-identical hormone replacement) and to consider bio-identical hormone replacement if they are found to be low. The book to read to become well informed about this is (terrible title, great book), Stay Young and Sexy with Bio-identical Hormone Replacement by Dr. Jonathan Wright, MD.

Please do not hesitate to get in touch if I can be helpful,

Kathie Roberts

Hello —I was wondering if you take Stronium also ? I want to try it but am fearful because I heard negitive things about it
Thank You,
Kathie Roberts

Kathie Roberts

Could you please tell me something about Stronium ? I would like to take it if I can .
Thank You ,
Kathie Roberts

Lara Pizzorno

Hi Kathie,

Yes, I take strontium – I am using AlgaeCal’s products, both their AlgaeCal Plus (their calcium product) and their Strontium Boost. I have been taking both for about a year now.

Did you see the blog I wrote reviewing all the research on strontium over the last 30 years? After carefully looking at all these research papers, I am convinced natural forms of strontium (like strontium citrate) are very safe and helpful for building bone. You just need to be sure you are getting about twice as much calcium as strontium from your diet and supplements. The AlgaeCal supplements give you the correct amounts of both calcium and strontium. I take their calcium product in the morning when I brush my teeth and at night right after I brush my teeth before going to bed – that way is easiest for me to remember it. I keep both bottles right next to my toothpaste. I take the Strontium with my lunch ( or mid-afternoon). I work mostly from a home office, so it’s easy for me to take at lunch; if I have to be out for a meeting or some other appointment, I just put the 3 capsules in a snack size ziploc bag and throw it in my purse.

Here is a link to my blog on strontium, in which I tried to cover everything and respond to many questions I have received about the safety and efficacy of strontium:

If you have more questions, please don’t hesitate to get in touch. YOU are the reason I am writing,

Be well!

Kathie Roberts

Thank you so much for answering back on the Stronium question . I am going to try it all because of you .

Yes I did read your piece on Stronium and thought it was very interesting . Now -my question is that could I take the calcium in the morning and the Stronium before I go to bed at night so it could settle into my system ? I already have osteoprosis [sp] and and trying to fight it with all I know how . I do some excercises for posture and my husband and I take a walk for about a mile with the dog everyday. We also take some strengh and balance classes at our Church which are offered to Seniors. Do you know of anything else I could do to help these old bones last longer ? I also work with weights at the church .
Thank you for all your help and I am anxious to read your book ”Your Bones” which I ordered .
Thanks again ,
Kathie Roberts

Lara Pizzorno

Hi Kathie,
Yes, of course, you could take your calcium in the morning and the strontium at night. The only issue is taking calcium and strontium at different times of day because these two minerals compete for absorption, and calcium will win out. So, if you take them at the same time, you won’t get much benefit from the strontium. If you are taking AlgaeCalPlus as your calcium supplement (a good idea since not only is this form of calcium highly bioavailable but it is delivered in a matrix of other minerals important for bone health, plus this supplement also provides vitamin D3 and vitamin K2 in its MK-7 form, the best forms of both of these very important nutrients for bone health) then you will need to take 4 capsules in the morning (or you could take 2 capsules in the morning and 2 with lunch or dinner) and then take your strontium citrate at night right before you go to bed.
I know of a great deal more you can do to promote healthy bones during our golden years — which is why I wrote Your Bones. It’s way too much to sum up here, but I promise, I have laid it all out in short, and I hope, easy to understand sections in the book. Your exercise program sounds great, especially since you, your husband and your dog can share in the fun. I will be writing more here at AlgaeCal about exercises you can easily do even at home with no special equipment that will help you have healthy bones, so I am hoping to give you some additional ideas that you will enjoy. Be well! Lara


Hi Lara,
I’ve taking Algae Cal since September 2011 and after 6 months I’ve got my bone mineral density checked on April 23, 2012. The results was the bone mineral density of the lumbar spine shows significant bone loss while there is a significant improvement in the left femoral neck in the interim compared to 2011.
In 2011:
Lumbar spine BMD 0.841, T-score -1.9
Total hip (femoral neck) BMD 0.677, T-score -1.5

In 2012:
Lumbar spine BMD 0.795, T-score -2.3
Total hip (femoral neck) BMD 0.733, T-score -1.0

I’m still taking AlgaeCal capsules every day 2 caps with breakfast and 1 with dinner
My question is: Should I increase to 5 capsules and add Strontium Boost or Vitamin K2 (MK7)? The only problem is I lived in Toronto, Canada and non of the health store carry Strontium Boost. Can I replace it with any other brand as long as the ingredients contain strontium citrate? I was told by my doctor that I need to take 1200 mg of calcium per day. Please advise.

Lara Pizzorno

Hi Bea,
Some possibly good news for you — your decrease in spine BMD may be an artifact of the reading of your x-ray or could be due to use of a different type of DXA machine — there are several different ones, and their readings vary. In other words, you may not have actually lost BMD in your spine. Please ask the lab to check their results/reading in comparison with your earlier DXA — was the same kind of machine used? And where they triangulate to take the BMD reading can greatly affect it! You want to be sure the reading was taken from the exactly the same area as before. RE strontium — any supplement providing strontium citrate will do, but why not just order Strontium Boost on-line and have it delivered? If you are already using AlgaeCal Plus and order Strontium Boost delivered for a 6 month trial, if your BMD does not go up, you have the advantage of the double your money back guarantee from AlgaeCal.
Re your doctor’s recommendation for 1,200 mg of calcium per day — this refers to your TOTAL intake from diet and supplements. Many foods contain some calcium — not just dairy foods (cow or goat or sheep), but a variety of leafy greens, like spinach, also soy foods like tofu and soy milk, sesame seeds, sardines, etc. In Your Bones, I provide a table listing a wide variety of foods rich in calcium and how much a serving of each contains, so you can easily figure out what your typical diet is giving you — you are likely to be consuming several hundred milligrams of calcium in your diet already.
RE K2– if you are taking AlgaeCal Plus, you are getting an effective dose of K2 as MK-7 (100 mcg). How much vitamin D3 are you taking and what are your vitamin D levels? AlgaeCal Plus (4 capsules daily) is giving you 1,600 IU of D3. If your blood levels of 25(OH)D are low (optimal is 60-80 ng/mL) and you are taking additional vitamin D3, then you may wish to take additional K2. Remember, vit D increases your body’s ability to absorb calcium; vitamin K2 activates the proteins that ensure that calcium is deposited in your bones and kept out of your arteries. If your blood levels of vit D are within optimal range with AlgaeCal Plus (and some spring and summer sunshine–FINALLY!), then you won’t need additional K2.
Hope this helps, Lara


Hi Lara,
Thank you very much for replying my e-mail.
As far as I know, the lab that I go to is using the same DEXA machine. I go to the same lab for my yearly BMD test in order to get a comparison results from the previous year.
On my last e-mail, I mentioned that I’m taking AlgaeCal which is the AlgaeCal Plant Calcium + D3, 2 caps with breakfast and 1 cap with dinner, altogether 750 mg Calcium, 65 mg magnesium and 1000 iu of Vitamin D3. And on top of that, I am taking additional 1000 iu of USANA Vitamin D3. Just want to let you know that in Canada, we don’t have the AlgaeCal Plus in the market. Last Thursday, I got my blood work done for Calcium and Vitamin D3 level, I will keep you informed once I get the results.
Should I continue taking AlgaeCal Plant Calcium + D3 and add Strontium Boost OR should I switch to AlgaeCal Plus and add Strontium Boost? Please let me know which one works more effectively. By the way, I don’t think I am eligible for 6 months trial, I won’t be able to double my money back guarantee from AlgaeCal since I’m in my early post menopause, I haven’t had my monthly cycle for 4.25 years.
Looking forward to hear from you!
Thank you,

Vona Marengo

My renam specialist has had me cut the dose of foamaz in half but I am not going to take it at all even though I have osteopenea (SP) I was wondering if you e-cookbook was vegetarian or not, as I have been vegetarian and am now vegan. I don’t need recipes that have animal products in them I do know lots of foods with calcium but I realize that it is ore than calcium that makes our bones gow strong! I knew these things asbout fosamax but I didn’t realize I had other choices!

Irene Phillips

Was on BONIVA for over 5 years, I am 62 now, stopped in July. Should I do something more then my regular meds: 2 blood pressure, crestor, lithium.
I have pain in my legs & especially left ankle. Rash on bottom of legs near ankle. No blisters, just under skin. Little red dots then turn brown. Dermat & internal medicine etc they do not know what it is. X ray on ankle nothing broken. Check legs for blood flow?
As usual I am weird.
Have a great day. Other people have much worse health problems.

Lara Pizzorno

Hi Irene,
Please accept my apologies — AlgaeCal has been upgrading their blog, and I have just received a number of questions that were submitted to me months ago.
YES you should definitely do something more to determine WHY your blood pressure is elevated – high blood pressure is very inflammatory, and inflammation promotes bone loss. I urge you to get a copy of the 2nd edition of Your Bones and read up on all the factors that can contribute to bone loss — and what to do to lessen them. Fortunately, neither Crestor (a statin) nor lithium has been shown to actively promote bone loss, but these drugs are not dealing with the CAUSES of your high cholesterol or the reasons why you have been prescribed lithium. My best advice to you is to find a highly educated functional medicine practitioner, a physician who has done postgraduate training to learn how to identify the true causes of illness and FIX them, not just prescribe drugs that suppress symptoms. The best place to locate such a physician is through the Institute for Functional Medicine — here is a link to their website where you will see a Find A Practitioner link that can help you locate someone in your area.

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