Bisphosphonates for secondary bone cancer

Bisphosphonates are drugs that can be given to strengthen the bones, relieve bone pain and reduce the risk of getting a broken bone. They can also help reduce calcium levels in the blood.

Commonly used bisphosphonates are:

  • zoledronic acid
  • disodium pamidronate
  • sodium clodronate
  • ibandronic acid.

Bisphosphonates can be given as a drip into a vein, or as a tablet or capsule.

Side effects of bisphosphonates may include: muscle and joint pain, low levels of calcium in the blood and flu-like symptoms. Bisphosphonates taken by mouth may also cause indigestion or a sore throat.

If you haven’t seen a dentist for six months, or if you have dentures that don’t fit well, you should see your dentist before taking bisphosphonates. If you see your dentist during treatment, let them know that you are taking bisphosphonates.

Bisphosphonates

Your specialist team may recommend you have bisphosphonates.

These are drugs that strengthen the bones, relieve bone pain and reduce the risk of getting a broken bone (fracture.) They are also given to treat high levels of calcium in the blood (hypercalcaemia).

When cancer cells spread to the bone, they produce chemicals that affect the osteoclasts (the cells that destroy old bone). The osteoclasts become overactive, so more bone is broken down. This commonly causes small holes in the bone.

Bisphosphonates work by reducing the activity of the osteoclasts.

There are different types of bisphosphonate. The one you have will depend on your general health and the type of cancer you have. Commonly used bisphosphonates are:

  • zoledronic acid
  • disodium pamidronate
  • sodium clodronate
  • ibandronic acid.

You may have bisphosphonates as a drip (infusion) into a vein (intravenously). This is often given in the outpatient department every 3 to 4 weeks. Each treatment usually takes 15 to 60 minutes. Or you may take your bisphosphonates as tablets or capsules.

If you are given tablets or capsules to take, you’ll be asked to take them on an empty stomach at least half an hour before food. You can’t eat or drink for six hours (usually overnight) before taking some of the tablets, and they should be taken when you’re sitting or standing, not lying down. This helps the drug move quickly into the stomach and reduces the risk of it staying in the throat or gullet where it can cause irritation. Your doctor, nurse or pharmacist will explain how you should take your tablets.


Possible side effects of bisphosphonates

Side effects of bisphosphonates may include:

  • pains in the muscles and joints
  • low levels of calcium in the blood – your doctor will probably advise you to take calcium and vitamin D to prevent this
  • flu-like symptoms, which usually settle after the first dose.

Oral bisphosphonates (taken by mouth) may also cause:

  • indigestion
  • a sore throat or inflamed gullet.

A very rare side effect of bisphosphonates is osteonecrosis of the jaw. This is when healthy bone tissue in the jaw becomes damaged and dies. It happens more commonly in people who have teeth removed or other dental procedures while taking bisphosphonates. It’s more common when bisphosphonates are given by injection rather than as tablets or capsules. It can result in poor healing of the gums or loosening of the teeth.

You should see your dentist before taking bisphosphonates if you’ve not seen a dentist for six months, or if you have dentures that don’t fit well. It’s important to let your dentist know that you’re taking bisphosphonates. This is because you shouldn’t have any dental extractions (removal of a tooth or root) or implants during treatment.

If you need to have a tooth or root taken out, you should let your doctor know before you have it done. Your doctor may temporarily stop your bisphosphonates while you have the extraction and until the tooth socket has fully healed.

It’s still all right to have tooth filling, scaling, polishing or gum treatments.

We have more information about the different types of bisphosphonates.