Decision box

Bisphosphonates (alendronate, risedronate and etidronate) are taken daily, weekly or monthly to reduce the risk of osteoporotic fractures occurring most commonly in the spine, hip and wrist. This medication slows down the cells that remove old bone tissue.

• Women diagnosed with low bone mineral density or with a recent fracture in the bones of their spine.
• Women over the age of 50 at moderate to high risk of having an osteoporotic fracture in the next 10 years. Risk level is evaluated using a risk calculator such as the FRAX, or the CAROC
  • high risk: more than 20% probability
  • moderate risk: 10-20% probability
  • low risk: less than 10% probability

• There are pros and cons to taking this medication: 
  • PROS: 5 to 6% of women taking bisphosphonates for 1 to 4 years will be protected from vertebral fractures and as many as 2% will be protected from non-vertebral fractures. 
  • CONS: This medication can cause reversible side effects. 
• There is a lack of evidence: 
  1. on the long-term effects of bisphosphonates 
  2. lower quality evidence suggests an association between oral bisphosphonate use and atypical fractures and osteonecrosis of the jaw. 
• Osteoporotic fractures can also be prevented by taking calcium and vitamin D, smoking cessation, decreasing alcohol consumption, regular exercise, and/or by taking other medications (hormonal therapy, denosumab, teriparatide).