Use of bisphosphonates in orthopedic surgery: pearls and pitfalls

Orthop Clin North Am. 2014 Jul;45(3):403-16. doi: 10.1016/j.ocl.2014.03.006.


Bisphosphonates are medications known to decrease bone resorption by inhibiting osteoclastic activity. They are the first-line therapy for the treatment of osteoporosis because a significant body of literature has proved their efficacy in reducing the risk of fracture in the hip, spine and other nonvertebral osseous sites. In addition, the use of bisphosphonates has significantly decreased morbidity and increased survival, and they have also proved to be cost-effective. Unexpected adverse effects have been reported recently, but the benefit of bisphosphonates use outweighs the risks. This article reviews the current use of bisphosphonates in orthopedic surgery.

Keywords: Bisphosphonates; Bone turnover; Jaw osteonecrosis; Osseous metastasis; Osteoclast; Osteoporosis; Paget disease; Pathologic fractures.

Publication types

  • Review

MeSH terms

  • Arthroplasty
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / epidemiology
  • Bone Density Conservation Agents / pharmacology
  • Bone Density Conservation Agents / therapeutic use*
  • Bone Neoplasms / drug therapy
  • Bone Neoplasms / secondary
  • Combined Modality Therapy
  • Diphosphonates / pharmacology
  • Diphosphonates / therapeutic use*
  • Fractures, Spontaneous / drug therapy
  • Fractures, Spontaneous / surgery
  • Humans
  • Hypercalcemia / etiology
  • Legg-Calve-Perthes Disease / drug therapy
  • Legg-Calve-Perthes Disease / surgery
  • Multiple Myeloma / drug therapy
  • Neoplasms / complications
  • Orthopedic Procedures*
  • Osteitis Deformans / drug therapy
  • Osteolysis
  • Osteoporotic Fractures / drug therapy*
  • Osteoporotic Fractures / surgery


  • Bone Density Conservation Agents
  • Diphosphonates