How Effective Are Bisphosphonates in Treating Osteoporosis?

Osteoporosis weakens bones by reducing density, but bisphosphonates can help preserve strength by slowing down bone loss.

Bisphosphonates are drugs made from synthetic compounds that resemble natural minerals in the body. Since the 1990s, they’ve been used to treat osteoporosis and other bone conditions.

These drugs work by slowing down bone breakdown, helping maintain bone density.

Let’s review the benefits and risks of these drugs.

Benefits of bisphosphonates for osteoporosis treatment

Bisphosphonates effectively reduce the risk of fractures, particularly in the spine and hips.

They work by attaching to the bone and stopping the activity of osteoclasts, the cells that break down bone tissue.

By disrupting these cells, bisphosphonates slow bone loss and help maintain bone density, reducing the risk of fractures.

Bisphosphonates offer several benefits for osteoporosis treatment:

• Increased bone density: They help improve bone mineral density, which can make bones stronger and less likely to break.
• Reduced fracture risk: Bisphosphonates significantly lower the risk of fractures, especially in the spine, hips, and other nonvertebral sites.
• Effective for various types of osteoporosis: They are beneficial for treating osteoporosis in females who have experienced menopause, older males, and people with conditions such as glucocorticoid-induced osteoporosis .
• Long-term protection: By slowing down bone resorption, bisphosphonates provide long-term protection against bone loss.
• Potential reduction in pain: By preventing fractures, they can help reduce pain and improve quality of life for people with osteoporosis.

A review of studies of 24 trials found that bisphosphonates effectively reduce the risk of osteoporotic fractures, including both vertebral and nonvertebral fractures.

Zoledronic acid was found to be particularly effective, while etidronate showed no significant fracture prevention.

Risks of bisphosphonates for osteoporosis treatment

There is a possibility of side effects with bisphosphonates for osteoporosis treatment , including:

• gastrointestinal issues
• osteonecrosis of the jaw (lack of blood supply to jawbone)
• atypical femur fractures
• renal impairment
• bone pain
• acute phase reaction (flu-like symptoms)
• hypocalcemia

Which bisphosphonates are best for osteoporosis?

All bisphosphonates are designed to help increase bone density by slowing down the process of bone resorption, which leads to stronger bones. However, their effectiveness can vary depending on the specific drug, the dose, the method of administration (oral vs. intravenous), and individual response.

Research shows that bisphosphonates differ in how well they prevent fractures in osteoporosis:

• Zoledronic acid: Decreases the risk of spine fractures by about 70% and hip and other fractures by around 35%.
• Alendronate: Cuts the risk of spine fractures by about 50% and reduces the risk of hip and other fractures by around 30%.
• Ibandronate: Reduces the risk of spine fractures by about 50%, but does not consistently lower the risk of hip or other fractures.
• Risedronate: Lowers the risk of spine and other fractures by about 40%.

Based on its effectiveness and cost-effectiveness, zoledronate could be considered a first-line treatment option for those at increased risk of fragility fractures.

How to take bisphosphonates

To take bisphosphonates correctly:

• Follow instructions: Take as prescribed by your healthcare professional.
• Empty stomach: Take first thing in the morning, at least 30 minutes before eating or drinking anything other than water. Avoid fiber or activated charcoal supplements for at least 2 hours.
• Full glass of water: Use a full glass of plain, still water (about 8 ounces).
• Stay upright: Remain upright (sitting or standing) for at least 30 minutes to avoid esophageal irritation.

Does insurance or Medicare cover bisphosphonates for osteoporosis?

Insurance and Medicare often cover bisphosphonates for treating osteoporosis, but coverage details can vary based on your specific plan.

Bisphosphonates are typically covered under Medicare Part D (prescription drug plans) or Medicare Advantage plans with prescription coverage. However, some plans may require prior authorization or have specific formulary restrictions.

To ensure coverage, it’s important to have a documented diagnosis of osteoporosis. The relevant ICD-10 codes include:

• M81.0: Age-related osteoporosis without current pathological fracture
• M81.8: Other osteoporosis without current pathological fracture
• M80.0: Age-related osteoporosis with current pathological fracture

The takeaway

Bisphosphonates are effective treatments for reducing the risk of fractures in individuals with osteoporosis, making them a key option in managing and improving bone health.

Early intervention and proper management are crucial to maintaining bone health and preventing complications.

If you suspect you have osteoporosis, it’s important to consult with your healthcare professional for an accurate diagnosis.

Your doctor can recommend bone density testing and discuss treatment options, including bisphosphonates.