Bisphosphonates (BPs) are the most widely used drugs to treat osteoporosis. They have been prescribed to hundreds of thousands of patients every year for the past 3 decades. They bind to bone and protect it from resorption by inducing apoptosis of osteoclasts. 4 bisphosphonates are approved for the treatment of osteoporosis: alendronate, risedronate, ibandronate and zoledronate. These vary in their potency and the amount of evidence for their safety and efficacy.


+ Relatively inexpensive

+ Most evidence for their safety and efficacy (three decades of data on large patient populations)

+ Discontinuation = pre-treatment rates of bone loss, not higher


– A few rare cases of osteonecrosis of the jaw and atypical femoral fractures

– most often taken as an oral pill right after waking up, requires waiting 30 min before having breakfast.

– improvements in bone density and reductions in fracture risk not as high as with denosumab, PTH or romo