Irregular heartbeat a possible side effect of osteoporosis medication

The Bottom Line

  • Elderly people and postmenopausal women are at increased risk of osteoporosis, a condition that causes bones to become weak and/or brittle.
  • Bisphosphonates are drugs that strengthen bones and help prevent breaks. People who are prescribed bisphosphonates have a greater chance of irregular heartbeats (atrial fibrillation).
  • If you have osteoporosis, talk to your doctor about whether bisphosphonates are a good choice for you based on your own circumstances and risk of heart problems.

Osteoporosis is a condition that makes bones become more brittle or weak and more likely to break when a person falls (1). People of all ages can be affected, but postmenopausal women and older adults are at higher risk because their bones tend to be less strong to begin with (1,2).

Fortunately, there are drugs that help increase bone strength and help to prevent broken bones or fractures. Bisphosphonates are pills or injections that doctors commonly prescribe to people with osteoporosis. They are usually prescribed for a period of three to five years and work to slow bone loss (3).

Bisphosphonate therapy is widely recommended by medical experts and research shows they work well to help prevent broken bones among people at risk (4). But recently, concerns have been raised that these medications may increase the risk for heart-related problems (5).

The issue has prompted considerable research, including 12 studies selected for a systematic review to find out whether bisphosphonates are associated with heart conditions and problems (6). The studies involved over 190,000 men and women between the ages of 50 and 89 who had osteoporosis and/or had undergone surgery for hip fracture. They were given bisphosphonates, either in pill form or through an injection, including zoledronic acid (Reclast®, Zometa®), alendronate (Fosamax®), risedronate (Actonel®, Atelvia®), and ibandronate (Boniva®).

What the research tells us

People who were given bisphosphonates had an increased risk of irregular heartbeat (atrial fibrillation), which was sometimes serious enough to require a visit to the hospital. On the positive side, the drugs did not appear to increase the risk of stroke or any other cardiovascular incident causing death.

The benefits of bisphosphonates in improving bone strength are well documented and these medications are a good choice for many people to help them stay strong and mobile. However, those with less than healthy hearts may not be good candidates for bisphosphonate therapy. If you have osteoporosis, talk to your doctor about whether bisphosphonates are the best choice for you based on your own circumstances and risk of heart problems.

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Author Details


  1. Rachner TD, Khosla S, Hofbauer LC. Osteoporosis: now and the future. Lancet. 2011; 377:1276-1287. 
  2. US Preventive Services Task Force. Screening for osteoporosis in postmenopausal women: recommendations and rationale. Ann Intern Med. 2002; 137: 526–528. 
  3. Whitaker M, Guo J, Kehoe T, et al. Bisphosphonates for Osteoporosis – Where do we go from here? N Engl J Med. 2012; 366:2048-51.  
  4. Qaseen A, Snow V, Shekelle P, et al. Pharmacologic treatment of low bone density or osteoporosis to prevent fractures: a clinical practice guideline from the American College of Physicans. Ann Intern Med. 2008;194(6):404-415.  
  5. Pazianas M, Compston J, Huang C. Atrial fibrillation and bisphosphonate therapy. J Bone Miner Res. 2010; 25:2–10. 
  6. Sharma A, Chatterjee S, Arbab-Zadeh A, et al. Risk of serious atrial fibrillation and stroke with use of bisphosphonates: evidence from a meta-analysis. Chest. 2013; 144:1311-22.

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