Table 2. Adverse effects of osteoporosis drugs.

Drug	Common adverse events	Notable rare adverse events
Oral bisphosphonate	Hypocalcaemia Upper gastrointestinal effects (gastro-oesophageal reflux, erosive oesophagitis)	Osteonecrosis of the jaw* Atypical femoral fractures †
Intravenous bisphosphonates	Hypocalcaemia Flu-like illness following infusion	Osteonecrosis of the jaw* Atypical femoral fractures †
Denosumab	Hypocalcaemia Injection-site reactions Atraumatic vertebral fractures following discontinuatio	Osteonecrosis of the jaw* Atypical femoral fractures †
Raloxifene	Hot flushes Venous thromboembolism	Stroke
Teriparatide	Hypercalcaemia Injection-site reactions	Theoretical risk of osteosarcoma
Romosozumab	Injection-site reactions	Possible increased risk of major adverse cardiovascular events (myocardial infarction, stroke) Osteonecrosis of the jaw* (few case reports) Atypical femoral fractures † (few case reports)

* Risk factors include dental extractions, implants, poorly fitting dentures, pre-existing dental disease, glucocorticoid use and smoking.

† Risk factors include rheumatoid arthritis, increased femoral bowing, thicker lateral cortices at the femoral shaft and Asian ethnicity.