Editing Bisphosphonate (section)

===Common===
Oral bisphosphonates can cause upset [[stomach]] and [[esophagitis|inflammation]] and erosions of the [[esophagus]], which is the main problem of oral ''N''-containing{{explain|date=October 2020}} preparations, that is ones containing "normal" unbranched chains. This can be prevented by remaining seated upright for 30 to 60 minutes after taking the medication. Intravenous bisphosphonates can give fever and [[flu-like symptoms]] after the first infusion, which is thought to occur because of their potential to activate human [[gamma/delta T cells|γδ T cells]].

Bisphosphonates, when administered intravenously for the treatment of cancer, have been associated with [[bisphosphonate-induced osteonecrosis of the jaw|osteonecrosis of the jaw]] (ONJ), with the [[mandible]] twice as frequently affected as the [[maxilla]] and most cases occurring following high-dose intravenous administration used for some cancer patients. [[Phossy jaw]] has been described since Victorian times. Some 60% of cases are preceded by a dental surgical procedure (that involves the bone), and it has been suggested that bisphosphonate treatment should be postponed until after any dental work to eliminate potential sites of infection (the use of antibiotics may otherwise be indicated prior to any surgery).<ref>{{cite journal |vauthors=Woo S, Hellstein J, Kalmar J | title = Narrative [corrected] review: bisphosphonates and osteonecrosis of the jaws | journal = Ann Intern Med | volume = 144 | issue = 10 | pages = 753–61 | year = 2006 | pmid = 16702591 | doi=10.7326/0003-4819-144-10-200605160-00009| s2cid = 53091343 }}</ref>

A number of cases of severe bone, joint, or musculoskeletal pain have been reported, prompting labeling changes.<ref>{{cite journal |vauthors=Wysowski D, Chang J | title = Alendronate and risedronate: reports of severe bone, joint, and muscle pain | journal = Arch Intern Med | volume = 165 | issue = 3 | pages = 346–7 | year = 2005 | pmid = 15710802 | doi = 10.1001/archinte.165.3.346-b}}</ref>

Some studies have identified bisphosphonate use as a risk factor for [[atrial fibrillation]] (AF), though meta-analysis of them finds conflicting reports. {{As of|2008}}, the [[Food and Drug Administration|US Food and Drug Administration]] did not recommend any alteration in prescribing of bisphosphonates based on AF concerns.<ref>{{cite web|url=https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm070303.htm |archive-url=https://web.archive.org/web/20090710001533/http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm070303.htm |url-status=dead |archive-date=July 10, 2009 |title=Update of Safety Review Follow-up to the October 1, 2007 Early Communication about the Ongoing Safety Review of Bisphosphonates |access-date=2009-07-15 |date = October 2008|work=Postmarket Drug Safety Information for Patients and Providers |publisher=[[Food and Drug Administration (United States)]] }}</ref> More recent meta-analyses have found strong correlations between bisphosphonate use and development of AF, especially when administered intravenously,<ref>{{cite journal| date= June 1, 2014 |volume= 113 |issue= 11 |pages= 1815–1821 |journal= American Journal of Cardiology |title= Risk of Atrial Fibrillation With Use of Oral and Intravenous Bisphosphonates |vauthors= Sharma A, Einstein AJ, Vallakati A, Arbab-Zadeh A, Walker MD, Mukherjee D, Homel P, Borer JS, Lichstein E |doi= 10.1016/j.amjcard.2014.03.008 |pmid= 24837258 }}</ref> but that a significantly increased risk of AF that required hospitalization did not have an attendant increased risk of stroke or cardiovascular mortality.<ref>{{cite journal |journal=   Chest|date= October 2013 |volume= 144 |issue= 4 |pages= 1131–1322 |title= Risk of serious atrial fibrillation and stroke with use of bisphosphonates: evidence from a meta-analysis |vauthors= Sharma A, Chatterjee S, Arbab-Zadeh A, Goyal S, Lichstein E, Ghosh J, Aikat S |pmid= 23722644 |doi= 10.1378/chest.13-0675 }}</ref>