Bisphosphonates

Key Points

• Bisphosphonates reduce fracture risk in osteoporosis by inhibiting bone resorption.
• Oral bisphosphonates require specific administration: sitting upright 30–60 min after dose, with full glass of water.
• Osteonecrosis of the jaw is a rare but serious complication, especially with IV formulations.
• Calcium and vitamin D supplementation is typically required alongside therapy.

Mechanism

Bisphosphonates bind to hydroxyapatite in bone and are internalized by osteoclasts, inhibiting their resorptive activity. Bone mineral density is preserved or increased with long-term use.

Key Nursing Considerations

• Oral administration: take on empty stomach, remain upright 30–60 min, avoid food/drink (except water).
• Monitor for esophageal irritation with oral formulations.
• Dental exam recommended before initiation, especially IV formulations.
• Monitor serum calcium and vitamin D levels.

Related Concepts

• common-musculoskeletal-disorders-recognition-and-care-priorities - Osteoporosis prevention and management.