Bisphosphonate
Summary
Anti-resorptive drugs that suppress osteoclasts, improve BMD, but predispose to low-turnover bone complications, especially atypical femoral fracture and osteonecrosis of the jaw (ONJ).
Typical clinical context
- Long-term therapy for:
- Primary / secondary osteoporosis
- Metastatic bone disease (IV forms: zoledronate, pamidronate)
- Red flag: >3–5 years continuous use + new bone pain (thigh, groin, jaw).
Complications
Other radiology points
- Metaphyseal sclerotic bands in growing children on cyclical IV therapy
(“zebra stripe lines” – dense metaphyseal lines parallel to physes). - Long-term therapy may make bone look diffusely sclerotic and “strong”,
but mechanically brittle → don’t be reassured by BMD alone.
