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In medicine, bisphosphonates are medications which "contain P-C-P bonds, where P stands for phosphonates or phosphonic acids. These compounds affect calcium metabolism. They inhibit ectopic calcification and slow down bone resorption and bone turnover. Technetium complexes of diphosphonates have been used successfully as bone scanning agents."[1]

Bisphosphonates are used to prevent fractures among patients with osteoporosis or low bone mass. Other indications include glucocorticoid Induced Osteoporosis, hypogonadal osteoporosis in males, Paget's Disease of bone, Post-menopausal osteoporosis, Post-Menopausal Osteoporosis Prevention, Prevention of Glucocorticoid-induced osteoporosis.[2]

Examples of bisphosphonates include alendronate, risedronate, etidronate, ibandronate, pamidronate, and zoledronic acid.


Patients should also receive Vitamin D and calcium.

Adverse effects

Atrial fibrillation may be caused by zoledronic acid.[3]

Osteonecrosis of the jaw was first reported in September, 2003; however, one publication suggested biphosphonates were causal[4] whereas the other study did not make this assertion as the patients were also taking other medications[5]. The following month, Novartis which is the manufacturer of Zometa, tried to refute the claim.[6] A series of 63 patients were reported in 2004 in which the author asserted that biphosphosphonates were causal.[7] A systematic review of published cases was reported in 2006.[8] In March, 2004. The Food and Drug Administration asked Novartis to revise the label for Aredia.[9]



  1. Anonymous (2023), Bisphosphonate (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. Alendronate: Dosage, Usage and Warnings, American Society of Hospital Pharmacists & Medscape
  3. Black DM, Delmas PD, Eastell R, et al. (May 2007). "Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis". N. Engl. J. Med. 356 (18): 1809–22. DOI:10.1056/NEJMoa067312. PMID 17476007. Research Blogging.
  4. Marx RE (2003). "Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic.". J Oral Maxillofac Surg 61 (9): 1115-7. PMID 12966493.
  5. Wang J, Goodger NM, Pogrel MA (2003). "Osteonecrosis of the jaws associated with cancer chemotherapy.". J Oral Maxillofac Surg 61 (9): 1104-7. PMID 12966490.
  6. Tarassoff P, Csermak K (2003). "Avascular necrosis of the jaws: risk factors in metastatic cancer patients.". J Oral Maxillofac Surg 61 (10): 1238-9. PMID 14586868.
  7. Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL (2004). "Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases.". J Oral Maxillofac Surg 62 (5): 527-34. PMID 15122554.
  8. Woo SB, Hellstein JW, Kalmar JR (2006). "Narrative [corrected review: bisphosphonates and osteonecrosis of the jaws."]. Ann Intern Med 144 (10): 753-61. PMID 16702591.
  9. [Aredia]