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.

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
  • flu-like symptoms.

Bisphosphonates taken by mouth may also cause indigestion or a sore throat.

If you have not seen a dentist for six months, or if you have dentures that do not fit well, you should see your dentist before taking bisphosphonates.


Your specialist team may recommend you have bisphosphonates.

Bisphosphonates are drugs that help to:

  • strengthen bones
  • relieve bone pain
  • reduce the risk of a bone breaking (fracture)
  • treat high levels of calcium in the blood (hypercalcaemia).

Cancer cells that have spread to the bone produce chemicals that change the way bone cells behave. The cells that destroy old bone (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 bisphosphonates. The one you have will depend on your general health and the type of cancer you have. Commonly used bisphosphonates are:

You may have bisphosphonates as a drip (infusion) into a vein (intravenously). Usually, you will have this treatment as an outpatient. Treatment is often given every 3 to 4 weeks and usually takes 15 to 60 minutes.

Or you may take your bisphosphonates as tablets or capsules. Your doctor, nurse or pharmacist will explain how you should take your tablets. It is important that you take the bisphosphonates exactly as you have been directed.

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 is 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 always see your dentist before taking bisphosphonates. It is important to let them know that you are taking bisphosphonates. This is because you should not 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 is still safe to have tooth filling, scaling, polishing or gum treatments.

We have information about the different types of bisphosphonates.