How to Take BPs

Some bisphosphonates (BPs) are taken orally – once a day, twice a week, once a week, or once a month. Zoledronic acid is given intravenously (by IV) once a year.

The stomach does not absorb etidronate, alendronate or risedronate well. These drugs can interact with minerals, such as calcium, magnesium, aluminum and iron, as well as many substances in food and drink, and in other medications, which can prevent the BPs from getting absorbed.

For this reason, all oral BPs must be taken alone, on an empty stomach first thing in the morning, with a full glass of water. It is important to stay in an upright position (standing or sitting, not bending over or lying down) and refrain from eating or drinking anything but water for at least 30 minutes after taking one of these medications.

Your doctor and pharmacist will tell you exactly how to take your particular BP – the instructions will include information about food, beverages, vitamin and mineral supplements, and other medications.  

Side Effects

The side effects of oral BPs vary from medication to medication, but may include:

• Headache
• Difficulty swallowing
• Heartburn
• Upset stomach
• Nausea
• Abdominal pain
• Inflamed esophagus
• Gastric ulcers
• Gas and bloating
• Diarrhea

These can occur when you start taking the medication, but usually go away as your stomach gets used to them.

Rare side effects include:

• Changes in taste (eg. a metallic taste)
• Pain in the muscles, joints and/or bone
• Rash
• Dizziness
• Dry eyes
• Ringing in the ears
• Swollen feet or lower legs
• Feeling of weakness

The side effects of intravenous BPs can include:

• Fever and other flu-like symptoms
• Pain in the muscles and/or joints
• Headache

Rare side effects of some oral BPs (such as alendronate) and intravenous BPs include:

• Vision disturbances and blurred vision
• Osteonecrosis of the jaw (rotting of the jawbone) – affects 1/10,000-1/100,000 patients taking oral BPs for osteoporosis

If you are taking a BP, inform both your doctor and your dentist if you are going to have an invasive dental procedure or if you have a wound with exposed bone in your mouth.

Cost

BPs are expensive medications. Before having a prescription filled, check to find out whether your insurance company and/or provincial health plan covers the cost. Coverage varies from province to province.

To find out which osteoporosis drugs are covered in your province, click here to visit the Osteoporosis Canada website.

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