Intended for healthcare professionals

Clinical Review State of the Art Review

Bisphosphonates for the prevention and treatment of osteoporosis

BMJ 2015; 351 doi: (Published 02 September 2015) Cite this as: BMJ 2015;351:h3783
Treating osteoporosis with bisphophonates infographic
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  1. Spyridoula Maraka, instructor in medicine1,
  2. Kurt A Kennel, assistant professor of medicine1
  1. 1Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo Clinic, Rochester, MN 55905, USA
  1. Correspondence to: K Kennel kennel.kurt{at}


Osteoporosis is a systemic skeletal disorder characterized by bone loss, which leads to impaired bone strength and an increased risk of fractures. Two million fractures are attributed to osteoporosis annually in the United States and they are associated with serious morbidity and mortality. Bisphosphonates reduce the risk of fracture by suppressing bone resorption and increasing bone strength, and they have been widely used for the prevention and treatment of osteoporosis. However, the use of these drugs for the management of osteoporosis remains a clinical challenge. There are several important considerations including appropriate patient selection, pretreatment evaluation, potential adverse effects, patient preferences, and adherence. This review will discuss the evidence informing the clinical strategy for using bisphosphonates in patients with osteoporosis and those at high risk of fracture, focusing on the benefits and risks of treatment. We will also consider issues related to the monitoring and duration of treatment.


  • Thanks to Patricia Erwin for her help with the literature search and Michael R Gionfriddo for his editorial assistance.

  • Contributors: SM and KAK contributed equally to the writing of this article. KAK is guarantor.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: none.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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