Osteoporosis medications - bisphosphonate derivatives


Bisphosphonate derivative osteoporosis medications include:

  • Alendronate (Fosamax, Fosamax Plus D)
  • Risedronate (Actonel, Actonel with Calcium)
  • Etidronate (Didronel)
  • Ibandronate (Boniva)
  • Pamidronate (Aredia)
  • Tiludronate (Skelid)
  • Zoledronic acid (Reclast, Zometa)


Taking alendronate, risedronate, etidronate, ibandronate, pamidronate, tiludronate, and zoledronic acid may deplete calcium.


Calcium, along with vitamin D, keeps your bones strong and healthy. Low levels of calcium may cause:

  • Muscle cramps
  • Numbness or tingling in toes and feet
  • Irregular heartbeat
  • Depression
  • Bone pain
  • Spinal problems
  • Seizures

Taking alendronate, risedronate, and pamidronate may deplete phosphorus.


Phosphorus deficiency is rare, but low levels can cause:

  • Muscle pain and weakness
  • Bone pain
  • Confusion
  • Numbness and tingling in feet and toes
  • Loss of appetite
  • Increased risk of infections
  • Trouble breathing
  • Seizures
  • Irregular heartbeat

Editorial Note

The information presented here covers some of the nutrients that may be affected when you take certain medicines. If you have any of these signs and symptoms, it does not always mean you have low levels of these nutrients.

Factors that affect the level of nutrients are:

  • Your medical history
  • Diet
  • Lifestyle
  • How long you have been taking the medicine

Please talk to your health care provider. They can best address your health care needs and see if you are at risk for low levels of any nutrients.

Supporting Research

Gold Standard Drug Database. Drug Monograph: Alendronate, 2015. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-13. Accessed July 11, 2016.

Gold Standard Drug Database. Drug Monograph: Etidronate, 2015. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-236. Accessed July 11, 2016.

Gold Standard Drug Database. Drug Monograph: Ibandronate, 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-2654. Accessed July 11, 2016.

Gold Standard Drug Database. Drug Monograph: Pamidronate, 2015. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-461. Accessed July 11, 2016.

Gold Standard Drug Database. Drug Monograph: Risedronate, 2015. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-2139. Accessed July 11, 2016.

Gold Standard Drug Database. Drug Monograph: Tiludronate, 2012. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-2117. Accessed July 11, 2016.

Gold Standard Drug Database. Drug Monograph: Zoledronic acid, 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-2525. Accessed July 11, 2016.

Leone KA. Calcium, magnesium, and phosphorus. In: Adams JG, ed. Emergency Medicine. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 166.

Shenkin A, Roberts NB. Vitamins and trace elements. In: Burtis CA, Ashwood ER, Bruns DE, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 5th ed. St. Louis, MO: Elsevier Saunders; 2012:chap 31.

Smogorzewski MJ, Stubbs JR, Yu ASL. Disorders of calcium, magnesium, and phosphate balance. In: Skorecki K, Chertow GM, Marsden PA, Yu ASL, Taal MW, eds. Brenner and Rector's The Kidney. 10th ed. Philadelphia, PA: Elsevier; 2016:chap 19.

Yu ASL. Disorders of magnesium and phosphorus. In: Lee G, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier; 2016:chap 119.

Version Info

  • Last reviewed on 9/19/2016
  • Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M. Editorial team.

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