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“Introduction Treatment with bisphosphonates significantly reduces the risk of fractures in men and women with osteoporosis. The evidence is based on high-quality phase III randomized controlled trials (RCTs) with fracture as an endpoint [1–10]. The benefits of bisphosphonates also extend to other disorders of bone metabolism such as glucocorticoid-induced osteoporosis [11], Paget’s disease [12] and bone metastases [13, 14]. Treatment with bisphosphonates is

not without adverse effects, but they are generally minor and occur in a minority of patients. The most common adverse effect is gastrointestinal upset with the oral formulations, the frequency of which decreases with intermittent treatment such as once-weekly or monthly regimens. Intravenous (IV) administration of nitrogen-containing bisphosphonates may induce an acute phase reaction which manifests as fever, myalgia and arthralgia, although these side effects usually resolve within a few days of onset [3, 7, 15]. High doses of bisphosphonates given intravenously may impair renal function, and the kidney is a major route of elimination of the bisphosphonates. For this reason, bisphosphonates are not recommended for use in patients with severe renal impairment [16–18].

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