How can you decide about taking bisphosphonate medicine for osteoporosis?

Osteoporosis is a common disease, and it affects women and men. In Canada, 1 out of 3 women and 1 out of 5 men have osteoporosis. For every 100 people in Canada who break a bone, less than 20 will have a bone density test or get treatment for osteoporosis.

What is osteoporosis?

Osteoporosis is a disease that affects your bones. It means you have bones that are thin and brittle and have lots of holes inside them. This makes them easy to break. It can lead to broken bones (fractures), especially in the hip, spine, and wrist. These fractures may make it hard for you to live on your own.

Bisphosphonates are the most common medicines used to prevent bone loss. They may be taken as a pill or an injection into a vein. Bisphosphonates slow the way bone dissolves and is absorbed by your body. They can increase bone thickness and strength, and reduce the risk of broken bones.

What are key points about this decision?

• If you are at a higher risk of having a fracture, taking bisphosphonates is more likely to help you prevent a fracture. If your risk of a fracture is lower, it's less likely that these medicines will help you.
• Bisphosphonates may cause problems with the jaw or thigh bone. But most people do not have these side effects.
• Whether you take medicine or not, healthy habits can help protect your bones. Get enough calcium and vitamin D. Get regular weight-bearing exercise. Cut back on alcohol. And if you smoke, quit.

Who is helped the most by bisphosphonates?

• If you have osteoporosis or you have had a fracture, taking bisphosphonates lowers your risk of having a fracture.
• If you haven't had a fracture and you have low bone density (sometimes called osteopenia), taking bisphosphonates might lower your risk of having a fracture. This evidence is not as strong.

What are the side effects of bisphosphonates?

These medicines can have side effects, such as heartburn and stomach upset.

Certain bone problems have also been reported in people when taking bisphosphonates. Out of 1,000 people, about 1 person has a bone side effect during a year of taking bisphosphonates. That means 999 out of 1,000 people do not have a bone side effect.

These bone side effects include problems with the jaw bone (called osteonecrosis). They also might include a certain kind of fracture of the thigh bone (called an atypical fracture), but more research is needed to find out if taking bisphosphonates is a cause of these fractures.

Your decision

Thinking about the facts and your feelings can help you make a decision that is right for you. Be sure you understand the benefits and risks of your options, and think about what else you need to do before you make the decision.