Can some types of osteoporosis drugs actually hurt my bones?
Answer From Kurt A. Kennel, M.D.
Certain types of osteoporosis drugs have been associated with an increased risk of two rare but serious problems — osteonecrosis of the jaw and an unusual type of fracture in the upper thigh bone (femur).
Osteonecrosis of the jaw develops when the jawbone fails to heal after a minor injury, such as getting a tooth pulled. An impending atypical femoral fracture can cause pain in the thigh or groin that begins subtly and gradually worsens. It sometimes develops in both legs at once. If untreated, a complete fracture of the femur requiring surgery can occur even with normal weight-bearing.
Bisphosphonates — such as alendronate (Fosamax, Binosto), risedronate (Actonel, Atelvia), ibandronate (Boniva) and zoledronic acid (Reclast, Zometa) — and denosumab (Prolia, Xgeva) have been linked to osteonecrosis of the jaw and atypical femoral fractures.
The risk appears to increase with the length of time the drugs are taken.
In addition to treating osteoporosis, bisphosphonates and denosumab are also used to treat cancer that has spread to the bone. The risk of osteonecrosis of the jaw is much greater for people taking higher doses of these drugs to treat cancer than it is for people who are simply treating osteoporosis.
Sept. 23, 2015
Kurt A. Kennel, M.D.
See more Expert Answers
- Rosen HN. The use of bisphosphonates in postmenopausal women with osteoporosis. http://www.uptodate.com/home. Accessed Aug. 3, 2015.
- Medication-related osteonecrosis of the jaw — 2014 update. American Association of Oral and Maxillofacial Surgeons. http://www.aaoms.org/news/aaoms-position-paper-renames-and-expands-the-scope-of-bisphosphonate-relate. Accessed Aug. 3, 2015.
- Tyler W, et al. Atypical femur fractures. Clinics in Geriatric Medicine. 2014;30:349.
- AskMayoExpert. Bisphosphonates. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2015.
- Berenson JR, et al. Risks of therapy with bone antiresorptive agents in patients with advanced malignancy. http://www.uptodate.com/home. Accessed Aug. 3, 2015.
- Ferri FF. Bisphosphonate-related osteonecrosis of the jaw. In: Ferri's Clinical Advisor 2016. Philadelphia, Pa.: Mosby Elsevier; 2016. https://www.clinicalkey.com. Accessed Aug. 3, 2015.
- Kennel KA (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 9, 2015.