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Osteoporosis: bisphosphonates can cause muscular, bone and joint pain

Bisphosphonates can cause incapacitating musculoskeletal pain.

In postmenopausal women who are not deficient in vitamin D or calcium, the drug of reference for reducing the incidence of osteoporosis-related fractures (femur, vertebrae, etc.) is an oral bisphosphonate such as alendronic acid.

Bisphosphonates can cause pain in the muscles, bones and joints, observed in the days, months or years after chronic treatment has begun.

The pain is generally not localised, and is often described as severe, extreme and incapacitating. Many patients are unable to walk, climb stairs or carry out day-to-day activities, and need walking aids or even become bedridden.

These pains affect around 2% to 5% of patients treated, especially those taking a weekly oral dose. In most cases, halting the bisphosphonates leads to a slow improvement. In the case of musculoskeletal pain, it is worth questioning whether bisphosphonates could be the cause. It is sometimes worth considering halting the treatment for a trial period. This is sometimes preferable to an increased consumption of painkillers, which themselves can also cause adverse effects.

©Prescrire October 2008

Source: "Diphosphonates : douleurs osseuses, musculaires et articulaires". Rev Prescrire 2008; 28 (299): 670-671.

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