Bisphosphonates, The risks and benefits

Much has been written about the bisphosphonates (Fosamex, Actonel, Boniva) mostly in the lay press about the potential for osteonecrosis or bone death. Bisphosphonates are used as preventives against osteoporosis, or a loss of bone density. Osteoporosis has been linked to fracture and it is a condition that increases with age.
The incidence of osteonecrosis appears to be about 2-4% and occurs mostly in those treated with intravenous bisphosphonate. Further, it seems to occur more often in those treated with higher doses, patients, often with cancer. Those who have been on steroid drugs, are immunosuppressed, long time smokers and those with poor oral hygiene also seem to be at increased risk when taking the oral version of the drugs.
The bottom line: it is clear that there is minimal risk. Brushing your teeth, getting lots of weight bearing exercise, and taking your medications correctly (including calcium) seem to be the best means of minimizing your risk of both osteoporosis and the rare event of osteonecrosis secondary to bisphosphonate use either oral or intravenous.