How to take Bisphosphonates? | Osteoporosis Treatment

Fosamax and Actonel (bisphosphonate) are taken once a week (on the same day).
To be taken first thing in the morning with empty stomach 2 hours before eating or drinking anything other than plain water. If you take it with food or drink other than water, only a small amount of the medicine is absorbed.
You need to swallow the tablet with a full glass of water and sit upright for 30 minutes so that it does not irritate the esophagus.
Bisphosphonate is to be taken three to five years continuously after that it can be stopped for two years and the patients can continue to benefit from its use.

Calcium and vitamin D

You need to have adequate calcium and vitamin D in the blood when you take bisphosphonate.
Calcium and vitamin D are normally taken every day at a different time to the bisphosphonate.

What are the possible side-effects?

The most common side-effects (nausea, indigestion, tummy pain, diarrhoea or constipation) usually happen in the first month of treatment but usually go away after this.
Other common side-effects (joint and muscle pain) can happen a few days or a few months after you first start treatment and normally goes away after you stop taking a bisphosphonate.
Less commonly but more serious side-effects – inflammation or ulcers of the oesophagus or a narrowing of the oesophagus. If you have difficulty or painful swallowing, worsening heartburn or chest pain, you should stop the tablets and see your doctor.

You cannot take a bisphosphonate if:

You have low calcium levels in your blood
You have untreated vitamin D deficiency
You are pregnant or breast-feeding
Your kidneys do not work very well
You cannot sit upright or stand for 30 minutes after you have taken the tablet
You have problems with your oesophagus including narrowing of the oesophagus or Barrett’s oesophagus.

How do I keep my bones strong?

Regular weight-bearing exercise e.g. jogging, skipping, brisk walking, dancing
Stopping smoking
Limit alcohol intake
Eating adiet rich in calcium e.g. cow milk, cheese, green vegetables, broccoli, green beans, fish
Adequate sun exposure improves your vitamin D levels

Bone Mass Density & Bisphosphonate

The purpose of bisphosphonate therapy is to maintain the bone density.
Bone density scan (BMD) is the standard investigation to detect osteoporosis and monitor osteoporosis treatment.
BMD should be repeated yearly for monitoring.

Author: Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho), Orthopaedic and Spine Surgeon, Mount Elizabeth Hospital, Singapore