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My doctor wants me to take a bisphosphonate drug to help prevent bone fractures from osteoporosis. When I went on-line I found out these drugs can cause problems with the jaw. What can you tell me about this?

Bisphosphonates such as Fosamax, Actonel, andBoniva are agents that prevent bone resorption. Bone resorption is the process by which bone is broken down. In the process minerals are released and calcium is transferred from the bone into the blood. In postmenopausal women, the lack of estrogen results in an increase in bone resorption. This can lead to osteoporosis (decreased bone density) and bone fractures. Bisphosphonates are the first-line of pharmacologic (drug) treatment for osteoporosis. All drugs have potential side effects. Bisphosphonates can cause severe bone, muscle, and joint pain. In a small number of cases, bisphosphonates have been linked to osteonecrosis (death of bone) in the jaw. Many people have assumed that anyone on a bisphosphonate is at risk for jaw osteonecrosis. This simply isn't true. Patients at increased risk for jaw osteonecrosis are cancer patients receiving intravenous bisphosphonates. It is a very rare adverse event but one to be aware of. Other possible side effects of bisphosphonates include GI upset such as esophagitis, difficulty swallowing, or gastric ulcers. The risk of GI involvement can be decreased by taking the pill first thing in the morning (or day) with a full eight-ounce glass of water away from food or other drinks. Patients are advised to remain in an upright position (standing or sitting) for at least one-half hour after taking the drug. If you are immobilized for any reason and cannot follow these directions, some other antiresorptive drug may be better for you. Your doctor will be able to advise you what's best given your health information and DXA scores.

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