Osteoporosis Medications (Bisphosphonates)

Risedronate (Actonel)
Alendronate (Fosamax)
Ibandronate (Boniva)
Zoledronic Acid (Reclast)
Pamidronate (Aredia)
Etidronate (Didronel)

What are bisphosphonates and why are they used in lupus treatment?

Bisphosponates such as risedronate (Actonel), alendronate (Fosamax), ibandronate (Boniva), zoledronic acid (Reclast), and pamidronate (Aredia) are used to treat and prevent osteoporosis—or, bone thinning—which occurs when the bones lose calcium and other minerals that help keep them strong and compact. This condition can lead to fractures, bone pain, and shorter stature. Everyone is at risk for osteoporosis as they age, and women experience a greater risk of the condition after menopause. However, studies have shown that people with lupus are at an increased risk for osteoporosis due to the inflammation they experience with the disease. Certain medications taken by lupus patients also increase the risk of osteoporosis, especially corticosteroids such as prednisone.

How do bisphosphonates work?

Your bones are constantly remodeling in a process that removes old bone cells and deposits new ones. In people with osteoporosis, the bones lose minerals faster than they can be regenerated. Bisphosphonates help prevent your bones from losing calcium and other minerals by slowing or stopping the natural processes that dissolve bone tissue. In doing this, they help your bones remain strong and intact. If you have already developed osteoporosis, these medications may slow the thinning of your bones and help prevent bone fractures (broken bones). In fact, studies have shown that alendronate (Fosamax) and risedronate (Actonel) can lower your risk of fractured vertebrae—bone segments that make up your spine—by 50%. Similar studies demonstrate that these medications can lower the chance of breaking other bones by 30-49%.

What are the usual doses of bisphosphonates, and what should I remember while taking these medications?

Most bisphosphonates are taken anywhere from once a week to once a month. All of these medications come in tablet form except for zoledronic acid (Reclast), which is given intravenously (IV) once per year. Both women and men may take bisphosphonates.

You should take these medications in the morning with a full glass of water at least a half-hour before eating, drinking, or taking other medications. Do not lie down for 30 minutes after taking the medication.

What else can I do to maintain strong, healthy bones and lower my risk of developing osteoporosis?

It is important for you to take other steps to help keep your bones healthy and strong. Exercise and movement are important for the health of your bones, joints, and muscles and may lower your risk of osteoporosis. Walking, stretching, yoga, and other activities will help ward off bone thinning and muscle loss. Studies have shown that people who live more sedentary lifestyles are at an increased risk of developing osteoporosis. In addition, your doctor will most likely recommend that you take calcium and vitamin D supplements while taking bisphosphonates, since vitamin D helps your body to absorb calcium. It is important that you also try to eat foods rich in calcium, such as milk, light ice cream/frozen yogurt, cottage cheese, pudding, almonds, broccoli, fortified cereal, oranges, yogurt, hard cheese, soybeans and soymilk, navy beans, oysters, sardines, and spinach.

Your doctor will most likely recommend that you get a bone density scan, or DEXA scan, every two years to evaluate your response to treatment.  The test takes only about fifteen minutes to perform and can provide your doctor with valuable information regarding the health of your bones.

What are the side effects of bisphosphonates?

Potential side effects of these medications include:
• Heartburn, stomach pain, and throat irritation
• Headache
• Muscle and joint pain
• Flatulence (constipation, diarrhea, gassy stomach)
• Dysphagia (difficulty swallowing)
• Pain or burning under the ribs or in the back
• Jaw pain, numbness, and swelling
• Dizziness, weakness
• Allergic reaction
• Reclast may be linked to an irregular heartbeat called atrial fibrillation.

In addition, some people have reported problems with bone healing (specifically, osteonecrosis of the jaw), especially after dental extractions or implants. Talk to your doctor if you plan to have this sort of treatment, since she/he will most likely recommend that you stop taking these medications before the event and begin taking an antibiotic. Also talk to your doctor if any of the side effects you experience are particularly bothersome.

Who should not take bisphosphonates?

The following people should not take bisphosphonates unless your doctor approves the treatment:

• Pregnant women or women planning to become pregnant
• People with severe kidney problems
• People with esophagitis (inflammation of the esophagus, the tube down which food travels from your mouth to your stomach)
• People who are currently taking parathyroid hormone (Forteo), although exceptions may be made.

Talk to your doctor if you have low blood calcium (hypocalcemia), a vitamin D deficiency, kidney disease, or an ulcer in your stomach or esophagus, since you may not be advised to use these medications.

What if I am taking other medications?

Certain medications can affect how your body deals with bisphosphonates. Your lupus treatment may involve several medications, but you should still tell your doctor if you are taking any other medicines—prescription drugs, over-the-counter medications, supplements, and vitamins—especially NSAIDs, such as ibuprofen (Advil, Motrin), celecoxib (Celebrex), naproxen (Aleve, Naprosyn), meloxicam (Mobic), and diclofenac (Voltaren, Cataflam). In addition, antacids and other supplements that contain aluminum, calcium, and magnesium can interfere with how your body absorbs bisphosphonates, so you should not take these medicines for at least 30 minutes after taking your bisphosphonate tablet.