What Is Infusion Therapy and How Does It Help Osteoporosis?

Infusion therapy involves medications administered through a needle or a tiny tube inserted directly into your veins. People with osteoporosis (a condition that causes weak and brittle bones) can get certain drugs by infusion.

Depending on the medication, people who opt for infusion therapy will get an infusion as frequently as once every three months, or rarely as once a year. Some find this treatment option more convenient and with different side effects than oral osteoporosis medications.

In this article, you can read about options for osteoporosis infusion therapy, benefits, side effects and complications, and what you can expect from treatment. 

healthcare provider adding a medication to an infusion bottle

yacobchuk / Getty Images

Types of Infusion Therapy for Osteoporosis

There are various treatment options for osteoporosis. One common group of drugs for osteoporosis is bisphosphonates. They work by interfering with the cells that break down bone and lead to increased bone mass and strength over time.

Providers often recommend oral bisphosphonates for osteoporosis due to their effectiveness and relative affordability. Oral forms include drugs like Fosamax (alendronate) and Actonel (risedronate).

Bisphosphonate drugs are available in pill form or given intravenously (into the vein) as an infusion.

Infusion Therapy Drugs

There are two types of bisphosphonates currently approved to treat osteoporosis with infusion therapy in the United States: Boniva (ibandronate) and Reclast (zoledronic acid).

Boniva (Ibandronate)

Ibandronate is one of the two drugs currently approved by the Food and Drug Administration (FDA) for bisphosphonate infusion therapy for osteoporosis. It is given intravenously once every three months. An oral version is also available.

Ibandronate is effective at reducing the risk of fractures, but does not prevent them.

Reclast (Zoledronic Acid)

Reclast is the only other bisphosphonate infusion therapy drug approved by the FDA. People treated with this medication only need one infusion a year.

Both treatments are similar in effectiveness and potential side effects.

Benefits of Infusion

Infusion therapy has some key benefits compared to other osteoporosis treatment options. Oral bisphosphonates typically produce gastrointestinal side effects compared to intravenous medications which produce musculoskeltal side effects. Infusion therapy may be a more viable option if you struggle to tolerate oral bisphosphonates.

Side Effect Differences

Bisphosphonates pills may cause side effects like:

  • Esophageal irritation
  • Heartburn and reflux
  • Upset stomach

Whereas infusion therapy side effects typically include:

  • Bone pain
  • Joint pain
  • Muscle pain

Fewer Skipped Doses

People taking oral bisphosphonates may accidentally skip some of their scheduled doses, leading to decreased protection from their therapy compared to someone who takes it exactly as prescribed.

If you opt for a bisphosphonate infusion, you are less likely to skip a dose since infusions occur at regularly scheduled appointments. Some people get more osteoporosis protection from infusion bisphosphonate therapy than pills because they don't skip doses.

Side Effects and Complications

Infusion bisphosphonates have side effects that oral bisphosphonates don’t have. An infusion reaction is a potential side effect that can cause flu-like symptoms during or after the infusion. Symptoms include:

  • Bone or muscle pain
  • Chest tightness
  • Dizziness
  • Fatigue
  • Fever

Infusion bisphosphonates also share rare but sometimes severe side effects of oral bisphosphonates, such as:

  • Hypocalcemia (low calcium in your blood)
  • Osteonecrosis (death of bone tissue) of the jaw
  • Severe muscle, joint, or bone pain
  • Unusual fractures of the femur

What to Expect During Treatment

Infusion therapy treatments occur at a healthcare provider's office or an infusion clinic. You can eat and drink normally on the day of your infusion, but your healthcare provider may suggest you drink extra water. 

A nurse or technician will clean an area on your arm and insert the needle into a vein where the medication will enter.

You'll sit for at least 15 minutes during the infusion while a provider monitors you for side effects. Generally, you'll be able to leave right after the infusion.

Is Infusion Treatment Worth It?

Talk to your healthcare provider to decide whether infusion treatment is worthwhile. Although it is more expensive than bisphosphonate pills, it is much less costly than other osteoporosis medications, like Forteo (teriparatide).

Infusion bisphosphonate therapy might be right for you if: 

  • Bisphosphonate pills have not been effective.
  • You do not swallow pills easily. 
  • You experience stomach upset from oral bisphosphonates.
  • You have trouble remembering to take medications.


Infusion therapy for osteoporosis is an effective treatment option. The side effects differ from those associated with oral osteoporosis medications. Fewer doses could mean better medication adherence and improved outcomes. Talk to your healthcare provider to learn if infusion therapy is right for you.

A Word From Verywell

Working with your healthcare provider to assess your risk of fracture with osteoporosis is well worth the time. Infusion bisphosphonate therapy for osteoporosis, done four times yearly or less often, may help improve your bone health.

Frequently Asked Questions

  • Are intravenous bisphosphonates better than the pill form?

    Intravenous bisphosphonates are not better or worse than prescribed oral forms. However, they have different side effects than oral bisphosphonates, and some people find them more convenient.

  • Is infusion safe for all stages of osteoporosis?

    The potential side effects and risk of infusion therapy are the same for people with any stage of osteoporosis. Infusion bisphosphonate is safe, but it carries some risks, the same as every drug.

    Infusion therapy may be the right choice if your osteoporosis is moderate to severe. If you have mild osteoporosis, you and your healthcare provider should balance therapy risks with the risks of a future fracture.

  • Aside from medication, what are other ways you can treat osteoporosis?

    Lifestyle modifications are a key part of osteoporosis treatment. By exercising regularly, quitting smoking, and drinking moderately (or abstaining), you may be able to strengthen your bones. Getting enough vitamin D and calcium may also help.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Horikawa A, Miyakoshi N, Shimada Y, Sugimura Y, Kodama H. A comparative study between intravenous and oral alendronate administration for the treatment of osteoporosis. Springerplus. 2015 Nov 5;4:675. doi:10.1186/s40064-015-1474-9

  2. Tu KN, Lie JD, Wan CKV, et al. Osteoporosis: A review of treatment optionsP T. 2018;43(2):92-104.

  3. Food and Drug Administration. Boniva (ibandronate) injection, for intravenous use.

  4. Food and Drug Administration. Reclast (zoledronic acid) injection.

  5. Byun JH, Jang S, Lee S, Park S, Yoon HK, Yoon BH, Ha YC. The Efficacy of Bisphosphonates for Prevention of Osteoporotic Fracture: An Update Meta-analysis. J Bone Metab. 2017 Feb;24(1):37-49. doi: 10.11005/jbm.2017.24.1.37. Epub 2017 Feb 28. PMID: 28326300; PMCID: PMC5357611.

  6. Bone Health and Osteoporosis Foundation. Side effects of bisphosphonates (alendronate, ibandronate, risedronate and zoledronic acid).

  7. Miller PD, Pannacciulli N, Brown JP, et al. Denosumab or zoledronic acid in postmenopausal women with osteoporosis previously treated with oral bisphosphonates. J Clin Endocrinol Metab. 2016 Aug;101(8):3163-70. doi:10.1210/jc.2016-1801

  8. Toller CS, Charlesworth S, Mihalyo M, Howard P, Wilcock A. Bisphosphonates: AHFS 92:24J Pain Symptom Manage. 2019;57(5):1018-1030. doi:10.1016/j.jpainsymman.2019.01.017

  9. Jeremiah MP, Unwin BK, Greenawald MH, Casiano VE. Diagnosis and management of osteoporosisAm Fam Physician. 2015;92(4):261-268.

  10. Weaver CM, Gordon CM, Janz KF, et al. The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporos Int. 2016;27(4):1281-1386. doi:10.1007/s00198-015-3440-3

By Ruth Jessen Hickman, MD
Ruth Jessen Hickman, MD, is a freelance medical and health writer and published book author.