Osteoporosis is Optional - Part 4 - Side Effects Of Popular Drugs

Aug 8, 2025

 by Stephen Conca

In our last segment on Osteoporosis, we discussed that if most people knew how little these drugs help their overall fracture and mortality rate, they may choose not to take them

Today, we're going to talk about some of the side effects.

From 2008 to 2012, in post menopausal women, there was a decrease of about 50% in the use of biphosphonate drugs in the US. Researchers indicate that it is multifactorial; however, a common public awareness about side effects using these medications, such as atypical femur fractures and osteoporosis of the jaw, is probably the two that opened clients’ eyes to the potential side effects of these drugs.

These are rare, with atypical femur fractures occurring in about one in 300 patients treated for three years. 

These are called atypical femur fractures because these breaks occur not after a fall or other trauma, but during routine activities like walking, twisting at the waist, or even standing still.

These are devastating injuries often requiring multiple surgeries to stay at a rehabilitation facility, and could take months to walk normally again

This is the cruel irony, as these drugs are supposed to protect their bones.

Think about it this way: your entire skeleton is consistently being remodeled, with bone added in some spots and taken away in others, to conform to the changing demands of the bone loads. The cells that are continually building new bone are called osteoblasts, and the ones that remove old bone are called osteoclasts.

These drugs could prevent bone loss by reducing the active remodeling process. B phosphates in these drugs can cause the skeletal system to freeze, allowing the accumulation of microcracks over time, which can lead to fatigue fractures, also known as stress fractures.

As with anything in life, it all comes down to risk for benefits.

It all depends on your race and how long you’re on these drugs. Research has shown that in five years, white women had 36 hip fractures for every atypical femur fracture.  Hispanic women only get half the benefit of about 18 to 1, and for Asian women, it’s only about 5 hip fractures permitted for every femur fracture. 

At 10 years of exposure, the ratios get worse,16 to 1 for white women,  5 to 1 for Hispanic women, and only 1.5 to 1 for Asian women,  meaning that the devastating fractures prevented and caused by an Asian woman are nearly comparable.

The good news is that after stopping the drugs, the risk of femur fracture rapidly drops by 70% per year since the last use. 

Researchers suggest that a drug holiday should be considered after a few years on the drug to help mitigate the atypical fracture risk.

It is a crazy irony that, even though they are rare, drugs that are designed to help increase your bone mineralization can cause atypical fractures.

Here’s a clear side-by-side comparison of common osteoporosis medications and their side effects: