Bisphosphonates

Key points

• Bisphosphonates (alendronate, risedronate): adsorb to hydroxyapatite and inhibit osteoclast activity → ↓ bone resorption.
• Administration: swallow whole with water on an empty stomach, remain upright for 30 minutes (prevent oesophagitis).
• Side effects: oesophagitis, GI upset; rare — osteonecrosis of the jaw (risk with dental work, IV forms).
• Atypical femoral fractures with long-term use.
• Dental review recommended before starting; check calcium/vitamin D repletion first.

Decision points in this pathway

• Dental work needed?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.