Understanding Osteoporosis Medications (cont.)
Alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel) are used for both prevention and treatment of osteoporosis.
- How bisphosphonates work: These drugs slow bone loss by increasing bone formation and decreasing bone turnover. Calcium and vitamin D are required for bisphosphonates to work most effectively. Bisphosphonates are also effective in treating osteoporosis in men and people with corticosteroid-induced osteoporosis.
- Who should not use these medications: Persons with the following conditions should not use bisphosphonates:
- Allergy to bisphosphonates
- Abnormalities of the esophagus
- Inability to stand or sit upright for 30 minutes after taking a bisphosphonate
- Decreased kidney function
- Increased risk of aspiration (contents from stomach or throat go into lungs)
- Use: Various dosage regimens are used. Bisphosphonates may be taken daily for prevention or treatment, or a larger dose may be given once each week and now once a month with Boniva. It is important to take bisphosphonates only with a full glass of water and to stand or sit upright for 30-60 minutes after swallowing the drug. Do not take at the same time with your other medication. After 30 minutes, you can take your other medications that may be scheduled for the same time.
- Drug or food interactions: Food, caffeine, milk, orange juice, and antacids reduce the absorption of bisphosphonates from the stomach, potentially decreasing efficacy. Use with caution with other drugs that cause stomach or esophagus irritation, such as aspirin or aspirin products (salsalate or mesalamine [Asacol, Pentasa, Rowasa]).
- Side effects: Your doctor will monitor your blood to make sure you have adequate calcium and vitamin D levels. Gastrointestinal side effects, such as abdominal pain, constipation or diarrhea, gas, esophagus ulcer, or stomach bloating, may occur. Esophageal ulcers or swelling may be severe enough to cause bleeding and has resulted in hospitalization, even death. Standing or sitting upright for 30 minutes after taking bisphosphonates helps prevent the drug causing esophageal irritation. Call your doctor immediately if you experience any of the following side effects:
- Allergy symptoms, such as itching, hives, swelling of mouth or hands, tightness in chest, or trouble breathing
- Unusual or severe stomach or throat pain
- Coughing up or vomiting blood
Francisco Talavera, PharmD, PhD
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