Table 3.

Contraindications of bisphosphonates

Contraindication	Description
Hypocalcemia1	Bisphosphonates can further lower calcium levels
Esophageal abnormalities2	Risk of esophageal irritation or ulceration
Inability to stand or sit upright3	To prevent the medicine from causing esophageal irritation
Renal impairment4	Risk due to potential drug accumulation and adverse effects
Known allergy	Hypersensitivity to bisphosphonates or their components
Pregnancy and lactation	Potential fetal risk. Unknown if excreted in human milk
Atypical femur fractures5	Might need to discontinue therapy
Osteonecrosis of the jaw (ONJ)6	Rare risk associated with bisphosphonate use
Gastrointestinal issues7	Increased risk of esophageal side effects from oral bisphosphonates

¹Ensure correction of calcium levels before initiating therapy

²Includes conditions like stricture or achalasia that delay esophageal emptying

³Patients should be able to stand or sit upright for at least 30 min after taking oral bisphosphonates

⁴Dosage adjustments and careful monitoring may be necessary depending on the degree of renal impairment

⁵Particularly relevant if the fracture is suspected to be linked to bisphosphonate therapy

⁶Recommended dental check-ups before initiating therapy, especially if invasive dental procedures are planned

⁷Patients with active gastritis or reflux might be more susceptible