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Bisphosphonates for prevention of osteoporotic fractures

Bisphosphonates to prevent osteoporotic fractures in postmenopausal women

Presenting bisphosphonates to patients

To know more, see the PDF version of this Decision Box by clicking here.

  • What are bisphosphonates for?Learn more

    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.

  • Among postmenopausal women, who might consider using bisphosphonates?Learn more
    • 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
  • Why do patient preferences matter when making this decision?Learn more
    • 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).
We recommend that...

We recommend that...

Both taking the medication and not taking the medication are acceptable options, so we propose that:

  1. The decision takes into account the patient’s values and preferences
  2. The clinician shares this decision with the patient

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