Which are major adverse effects of bisphosphonates that you should counsel patients about?

• A. Esophagitis/ulcers, osteonecrosis of the jaw, atypical femur fractures, hypocalcemia; GI upset is common
• B. Hypertension and tachycardia
• C. Hyperglycemia
• D. Hair loss

Answer: (D)

The important adverse effects to counsel patients about with bisphosphonates are related to irritation of the esophagus and serious but less common skeletal complications from long-term use. The esophageal-related issues include esophagitis or ulcers and general GI upset, which is why these meds are taken with a full glass of water and patients are advised to stay upright for at least 30 minutes after taking them. Long-term use can be associated with osteonecrosis of the jaw, a condition where the jawbone doesn’t heal after dental procedures or injuries, so dental health and procedures should be discussed before starting therapy. Atypical femur fractures are another important risk with prolonged therapy; sudden thigh or groin pain should prompt evaluation, as these fractures can occur with minimal trauma and may require dose adjustment or stopping the medication. Hypocalcemia is a potential issue, especially if calcium or vitamin D levels are low before starting treatment, so ensuring adequate calcium and vitamin D status is important and symptoms like tingling, numbness, or muscle cramps should be reported.

Hair loss is not a recognized major adverse effect of bisphosphonates, and hypertension/tachycardia or hyperglycemia are not typical concerns with these medications.