Alendronate (FosamaxI1), risedronate (Actonel), and ibandronate (Boniva) are medications from the class of drugs called bisphosphonates. Like estrogen and raloxifene, these bisphosphonates are approved for both prevention and treatment of postmenopausal osteoporosis. Alendronate is also approved to treat bone loss that results from glucocorticoid medications like prednisone or cortisone and is approved for treating osteoporosis in men. Risedronate is also approved to prevent and treat glucocorticoid-induced osteoporosis. Alendronate plus vitamin D is approved for the treatment of osteoporosis in postmenopausal women and in men. Risedronate with calcium is approved for the prevention and treatment of osteoporosis in postmenopausal women.

Alendronate and risedronate have been shown to increase bone mass and reduce the incidence of spine, hip, and other fractures. Ibandronate has been shown to reduce the incidence of spine fractures.

Alendronate is available in daily and weekly doses, while alendronate plus vitamin D is available in a weekly dose. Risedronate is available in daily and weekly doses, while risedronate with calcium is available in a weekly dose with daily calcium. Ibandronate is available in a monthly dose and as an intravenous injection administered once every three months.

Oral bisphosphonates should be taken on an empty stomach and with a full glass of water first thing in the morning. It is important to remain in an upright position and refrain from eating or drinking for at least 30 minutes after taking a bisphosphonate.

Side effects for bisphosphonates include gastrointestinal problems such as difficulty swallowing, inflammation of the esophagus, and gastric ulcer. There have been rare reports of osteonecrosis of the jaw and of visual disturbances in people taking bisphosphonates.

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WebMD Public Information from the U.S. National Institutes of Health