Bisphosphonates for secondary breast cancer

Bisphosphonates are also given to reduce high levels of calcium in the blood (hypercalcaemia), which we explain below.

You may be prescribed bisphosphonates when you’re diagnosed with secondary breast cancer in the bones| to reduce your risk of developing bone problems.  

Bisphosphonates can be given as tablets. They’re usually taken first thing in the morning, or given by a drip (infusion) in the outpatient department. The main bisphosphonates used are:

• clodronate (Bonefos®, Loron®) - a tablet that’s taken once or twice a day
• zoledronic acid (Zometa®) - given as a drip about once a month
• pamidronate (Aredia®) - given as a drip every 3-4 weeks
• ibandronate (Bondronat®) - given as a tablet once a day, or as a drip every 3-4 weeks.

Side effects of bisphosphonates Back to top

The side effects are usually mild, but can include feeling sick, headaches, and flu-like symptoms, such as chills and muscle aches. Bisphosphonate tablets can sometimes cause diarrhoea, constipation and heartburn. If you’re having bisphosphonates by a drip, side effects can include a temporary increase in bone pain known as tumour flare. Your doctor can prescribe painkillers until this wears off.

Very rarely bisphosphonates can cause jaw problems called osteonecrosis of the jaw. Having dental treatment or dental problems can increase the risk of this. You’ll be advised to have a full dental check-up before you start taking bisphosphonates. Always let your dentist know if you’re taking bisphosphonates and let your cancer specialist know if you develop any problems with your teeth or jaw. Our cancer support specialists| can give you more information about this side effect.

High calcium levels in the blood (hypercalcaemia) Back to top

Secondary breast cancer in the bones may result in extra calcium being passed out of the damaged bone and into the blood. High levels of calcium in the blood can make you feel extremely tired| and thirsty, and make you pass lots of urine. It may also make you feel sick| or become irritable and confused. You may need to spend a few days in hospital for treatment.

Your doctor may ask you to start drinking plenty of water and put up a drip to give you extra fluids. This increases the amount of fluid in the blood, encouraging the kidneys to remove the extra calcium and flush it from the body in urine. You’ll be given bisphosphonates as a drip to speed up the process and this can be repeated every few weeks. Within a couple of days of having the bisphosphonate drip, you should feel much better.