Bisphosphonates

Endocrine & Metabolic

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Examples

alendronate (Fosamax)risedronatezoledronic acidibandronate

Prefix / Suffix: -dronate

Physiology

Bone is constantly remodeled by osteoclasts (resorption) and osteoblasts (formation). In osteoporosis, resorption exceeds formation.

Mechanism of Action

Inhibit osteoclast activity, reducing bone resorption and increasing bone density.

Indications

Osteoporosis (postmenopausal, glucocorticoid-induced, male)
Paget's disease
Hypercalcemia of malignancy
Bone metastases

Side Effects / Adverse Effects

Esophagitis, esophageal ulceration
Osteonecrosis of the jaw (rare, especially IV/dental procedures)
Atypical femur fractures (long-term use)
Musculoskeletal pain
Hypocalcemia
Acute phase reaction with IV (flu-like)

Contraindications

Esophageal abnormalities or inability to remain upright 30 min
Hypocalcemia
Severe renal impairment

Nursing Considerations

Take first thing in morning with full glass of plain water (not coffee, juice, mineral water)
Remain upright (sitting/standing) for at least 30 minutes after dose (prevents esophageal damage)
Take 30 minutes before any food, drink, or other medication
Ensure adequate calcium and vitamin D intake
Dental exam before starting and good oral hygiene (osteonecrosis prevention)
Notify provider before dental procedures
Report new thigh or groin pain (atypical fracture warning)

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Disclaimer: PharmPal Nurse is for education only and is not medical advice. Do not use it to diagnose, treat, prescribe, or make patient-care decisions; always verify with current drug references, your instructor, facility policy, and a licensed provider. In emergencies, call local emergency services.