Bisphosphonates including alendronate, ibandronate, risedronate, and zoledronic acid are used to treat osteoporosis. Common side effects are esophagitis, esophageal ulceration, abdominal pain, nausea, diarrhea, constipation, and blurred vision or eye pain. Nursing care instructions are to take the medication first thing in the morning with water on an empty stomach and remain upright for 30 minutes, avoid calcium for 30 minutes after, do weight bearing exercises daily, and notify the provider of swallowing issues. Bone density and serum calcium levels should be monitored regularly.

1. Bisphosphonates
alendronate
Ibandronate
Risedronate
IV infusion
(Fosamax)
(Boniva)
(Actonel)
– zoledronic (Reclast, Zometa)
Side Effects:
Esophagitis, esophageal ulceration
sit upright ambulate 30 min
abdominal pain, nausea,
diarrhea, constipation (all bisphosphonates)
notify provider
blurred vision & eye pain
Risk for hyperparathyroidism at higher dose
Nursing Care
Instructions for clients
Take first thing in the morning after getting out of bed.
Take an empty stomach
drinking at least 8 oz water w/tablets and @ least 2 oz H20 w/liquid
Sit or ambulate for 30 min after taking the medication.
Avoid all calcium-containing foods and liquids or any medications within 30 min
of taking alendronate.
Avoid chewing or sucking
Do weight-bearing exercises daily (walk 30 mins)
Notify the provider of difficulty swallowing, painful swallowing, and/or new or
worsening heartburn.
Skipped dose wait until next day 30 minutes before eating breakfast
Do not take two tablets on the same day.
Consume adequate amounts of calcium and vitamin D.
Tablets are prescribed once daily or once a week. Liquid form is prescribed
once a week.
Monitor the client–s bone density: bone density scan every 12 to 18 months.
Monitor the client–s serum calcium – expected reference range 9 to 10.5 mg/dL.