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Bisphosphonate Therapy

Bisphosphonates are a group of drugs that may be used when a cancer has spread to affect the bone or to treat a high calcium level. This page explains how they work, when they may be prescribed, how they are given and what side effects may occur.


Please note: You can also download a copy of this information leaflet at the bottom of this page or view our full list of information leaflets.

How do bisphosphonates work?

Healthy bones are constantly being broken down and renewed. This process is a delicate balance of the breaking down of old bone and the rebuilding of new bone. When cancer spreads to affect the bone, known as bone metastases, the process is disrupted and more bone is broken down than is replaced. This can cause pain and weakening of the bones, which means they may be more at risk of fracture. Bisphosphonates work by slowing down the process of bone breakdown.

Why are bisphosphonates prescribed?

Bisphosphonate medications have many uses and may be prescribed to you for one or more of the following reasons:

• To reduce and help control bone pain caused by cancer within the bone

• To reduce the risk of fractures at areas where the bones have been affected by cancer

• To reduce high calcium levels in the blood. This is a condition called hypercalcaemia and can be a complication of cancer and can occur whether or not cancer has affected the bones.

• To reduce the risk of thinning of the bone (osteoporosis) which can be caused if you are on steroid medication for a long time

How are bisphosphonates given?

There are a number of different bisphosphonate medications. The one most commonly prescribed at St Barnabas House is called Zolendronic acid (Zometa). This is given intravenously via a drip and takes about 15 minutes. Most people are given their treatment as an out-patient via the Day Hospice.

Before being given Zometa you will need to have a blood test to check your kidney function and calcium levels. This enables the Doctor to prescribe the correct and safest dose of bisphophonate for you.

When you are receiving infusions of Zometa you may experience a fall in the level of calcium in the blood. To prevent this you will be prescribed a calcium and Vitamin D tablet to take.

If you are prescribed intravenous bisphosphonate medication for bone pain or to reduce the risk of fracture with bone metastases the treatment is given once a month. This will continue indefinitely until your Doctor, in consultation with yourself, decides you will no longer benefit from them. If you are prescribed intravenous bisphosphonate medication for osteoporosis the treatment is given once a year.

What are the side effects of bisphosphonates?

Like any medication bisphosphonates can cause a variety of side effects.   The more common side effects usually occur within the first 48 hours after treatment and get better on their own. These include fatigue, headache, bone or muscle pain, or joint discomfort.   You may also experience flu-like symptoms such as fever, hot flushes and chills after the first treatment.

Less common side effects may include pain and/or redness or inflammation at the injection site.   You may also experience sleeplessness, tiredness generalised aches / pains and nausea and vomiting.

Rare side effects include persistent muscle cramps, difficulty swallowing, abdominal pain, agitation, dizziness, drowsiness and exhaustion. In patients receiving bisphonates for Osteoporosis for longer than 5 years there is an increased risk of hip fractures.

Intravenous bisphosphonates such as Zometa can, in rare cases, cause kidney damage. You can reduce the risk of this occurring by drinking well before your treatment to ensure you are well hydrated. Your kidney function will be monitored with blood tests before each treatment and the dose of bisphosphonate reduced or stopped if the tests show any signs of damage to your kidneys.

Rarely, inflammation of the eyes can occur after treatment with bisphosphonate. This usually occurs within 48 hours of treatment and can cause eye pain, redness, swellings and changes in your vision. If this occurs, you should contact your GP.   If the reaction is severe, you may need an urgent referral to an Ophthalmologist (Eye Specialist) for their assessment and advice.

Rarely, bisphosphonate infusions can cause potentially serious bone problems in the jaw. This is known as osteonecrosis of the jaw. This condition appears to be more common when people have had dental work whilst receiving bisphosphonates, therefore you are advised to consider having a dental examination and to complete any planned dental treatment before commencing bisphosphonates.   If you need to see a dentist at any time, please inform them that you are receiving bisphosphonates and ask them to contact a doctor at the hospice if they need any information and advice regarding the implications of this.  If you develop new jaw symptoms e.g. loose teeth, jaw pain, swelling, discharge or non-healing sores whilst on bisphosphonates please let your Doctor or Nurse know. When you have your first bisphosphonate infusion you will be given a reminder card about this.

Very rarely bisphosphonate infusions can cause potentially serious problems with the bones in the ear. This is known as osteonecrosis of the external auditory canal. This condition appears to be more common when people have been on bisphosphonates for longer than 2 years. If you develop new ear symptoms e.g. ear pain, discharge or ears infections whilst on bisphosphonates please let your Doctor or Nurse know.

Very occasionally bisphosphonates can trigger a severe allergic reaction. This is called anaphylaxis. The Doctors and Nurses giving your treatment are trained to recognise this and have medication prescribed that they can give to treat such a reaction should it occur.

Do you have any questions?

If you want further information about your bisphonate medication or have concerns about any of the information contained on this page, please do not hesitate to talk to your doctor or nurse who will be pleased to help.

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