St Barnabas Hospices (Sussex) Ltd
BISPHOSPHONATE THERAPY
PATIENT INFORMATION LEAFLET
Bisphosphonates are a group of drugs that may be used when a cancer has spread to affect the
bone. This information leaflet explains how they work, when they may be prescribed, how they are
given and what side effects may occur.
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
 To reduce the risk of thinning of the bone (osteoporosis) which can be caused if you are on
steroid medication for more than a few weeks
If you are prescribed 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.
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.
w.\group information\policies\clinical\patient & family information leaflets\stb patient information
leaflets\bisphosphonate therapy
Originator/Reviewed by: Clinical Medical Officer
Last Review:
Approval Date: August 2006
Next Review:
1
August 2015
August 2017
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 flulike 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 pain 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 in this leaflet, please do not hesitate to talk to your doctor or nurse who
will be pleased to help.
w.\group information\policies\clinical\patient & family information leaflets\stb patient information
leaflets\bisphosphonate therapy
Originator/Reviewed by: Clinical Medical Officer
Last Review:
Approval Date: August 2006
Next Review:
2
August 2015
August 2017