Side Effects of Bisphosphonate Medications

Bisphosphonate medications have become a common treatment for patients with osteoporosis. Bisphosphonate medications have been found to increase bone strength and lead to a lower chance of fracture in the first 5 years after starting the medication. Many patients have been prescribed a bisphosphonate medication (such as Fosamax, Reclast, or Actonel), and these patients should be aware of possible side effects of these drugs.

Woman pouring pills into her hand from pill bottle
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Upset Stomach/Esophageal Inflammation

One of the most common side effects of bisphosphonate medications is stomach upset. The medication can cause inflammation of the esophagus and even lead to erosions of the surface of the esophagus. When taking an oral bisphosphonate, it is recommended that you remain upright for 30 to 60 minutes after taking the medication.

Osteonecrosis of the Jaw

Osteonecrosis is a problem that causes bone cell death. Data suggests a higher chance of jaw osteonecrosis in patients taking bisphosphonate medications. This complication typically occurs in people taking IV doses of bisphosphonates, and is usually seen after a patient on bisphosphonate medication has had dental surgery involving the jaw.

Bone, Joint, and Muscle Pain

There have been reports of patients having severe muscle, joint, and/or bone pain after taking bisphosphonate medications. This complication may arise within a day, or possibly weeks or even months after starting bisphosphonate therapy. If severe muscle or bone pain is a problem, stopping bisphosphonate medication should be considered. Speak to your healthcare provider about your symptoms.

Femur Fracture

Unusual femur fractures have been found in some patients taking bisphosphonate medications for lengthy time periods. ​Research has investigated this finding to determine if the medication could contribute to these unusual types of fractures. It is still unclear if long-term use of bisphosphonates may contribute to fracture risk, but you should discuss with your healthcare provider if you should be taking these medications longer than a few years.

Atrial Fibrillation

Atrial fibrillation is an abnormal heart rhythm that can cause a rapid heartbeat. In reviews of some trial data, atrial fibrillation was found more commonly in patients taking some bisphosphonate medications, especially in elderly women. In reviews of other data, however, this association was not seen. Thus, it is unknown if this is a true side effect of the medication, but the FDA did put out a warning for healthcare providers to be aware of this potential association.

Other Possible Side Effects

As stated, the most common side effect of oral bisphosphonate medications is an upset stomach. Some of these other complications are possible but unlikely. Patients taking bisphosphonates should discuss with their healthcare provider how long to continue the medication. In addition, patients with other medical problems that can cause electrolyte imbalances or patients with kidney disease may need their dose of bisphosphonate medication adjusted. While all medications have possible side-effects and risks, it is important to remember that there are also risks of not taking a necessary medication. Your healthcare provider should be able to help you determine the best option given your specific circumstances.

4 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. National Library of Medicine: DailyMed. FOSAMAX- alendronate sodium tablet [drug label].

  2. Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D. American Association of Oral and Maxillofacial Surgeons’ position paper on medication-related osteonecrosis of the jaws—2022 update. J Oral Maxillofac Surg. 2022;80(5):920-943. doi:10.1016/j.joms.2022.02.008

  3. Black DM, Geiger EJ, Eastell R, et al. Atypical femur fracture risk versus fragility fracture prevention with bisphosphonates. N Engl J Med. 2020;383(8):743-753. doi:10.1056/NEJMoa1916525

  4. Fuggle NR, Cooper C, Harvey NC, et al. Assessment of cardiovascular safety of anti-osteoporosis drugs. Drugs. 2020;80(15):1537-1552. doi:10.1007/s40265-020-01364-2

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.