4.3.1 Rare but serious side effects of bisphosphonates

Bisphosphonates are known to be occasionally associated with a problem with bone and gum healing in the jaw, called osteonecrosis of the jaw (ONJ). This is more often associated with the high doses of bisphosphonates used in cancer treatment, but patients with poor dentition or significant planned dental work should not be prescribed intravenous bisphosphonates.

In rare cases the effective suppression of bone turnover is thought to increase the risk of a particular type of fracture in the thigh, called an atypical femoral fracture. This is less rare with long courses (>7 years) of bisphosphonates. But for those at high general fracture risk the benefits of bisphosphonate treatment far outweigh the risk of this rare possible side effect. For those at lower risk, reassessment of treatment after 5 years is recommended and there is fuller advice on this, and on treatment monitoring, within section 7 of the NOGG full guidance.

4.3 Drug treatment for osteoporosis: bisphosphonates