title: Benefits and risks of bisphosphonate therapy for osteoporosis.
abstract: BACKGROUND
  There has been considerable concern recently in the scientific and lay media regarding the benefits vs. the risks of bisphosphonates for the treatment of osteoporosis. Risks include possible associations with osteonecrosis of the jaw (ONJ) and atypical femur fractures. In this perspective, we review the use of bisphosphonates for the treatment of osteoporosis, including an objective assessment of the risks vs. the benefits of these drugs.
  
  
  METHODS
  Authors' knowledge of the field and results of focused literature searches are presented.
  
  
  RESULTS
  Bisphosphonates have proven efficacy in the prevention of bone loss and in the reduction of fractures in postmenopausal women and men with established osteoporosis. Although bisphosphonates, at doses used to treat osteoporosis, may be associated with an increased risk of ONJ and atypical femur fractures, many more fractures are prevented by the use of these drugs compared to the relatively low risk of these complications. Although oral bisphosphonates are associated with upper gastrointestinal side effects and iv bisphosphonates with acute phase reactions, the association of bisphosphonate use with esophageal cancer and atrial fibrillation is not well supported by current data.
  
  
  CONCLUSIONS
  Bisphosphonates have been proven to prevent fractures in patients with established osteoporosis or those who are at high risk of fracture. In contrast, the incidence of major complications associated with bisphosphonate use, such as ONJ and atypical femur fractures, is very low.
authors.affiliation: College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA. khosla.sundeep@mayo.edu
authors.forename: Sundeep
authors.initials: S
authors.lastname: Khosla
authors.forename: John P
authors.initials: JP
authors.lastname: Bilezikian
authors.forename: David W
authors.initials: DW
authors.lastname: Dempster
authors.forename: E Michael
authors.initials: EM
authors.lastname: Lewiecki
authors.forename: Paul D
authors.initials: PD
authors.lastname: Miller
authors.forename: Robert M
authors.initials: RM
authors.lastname: Neer
authors.forename: Robert R
authors.initials: RR
authors.lastname: Recker
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shane
authors.forename: Dolores
authors.initials: D
authors.lastname: Shoback
authors.forename: John T
authors.initials: JT
authors.lastname: Potts
mesh_terms: D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D004164:Diphosphonates / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005265:Femoral Neck Fractures / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D008954:Models, Biological; D010020:Osteonecrosis / Q000139:chemically induced / Q000453:epidemiology; D010024:Osteoporosis / Q000188:drug therapy*; D018570:Risk Assessment
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates