Bisphosphonates
Bisphosphonates don’t usually cause too many side effects. They tend to be mild if you do have them. Everyone reacts differently to drugs and you may have one or more side effects.
This is more common when you have the bisphosphonate as a drip (infusion) rather than bisphosphonate tablets. Symptoms usually last for a few hours. Taking painkillers like paracetamol can help.
Talk to your doctor or advice line if you have a fever or flu-like symptoms.
You will have blood tests to check the levels of calcium and other minerals such as potassium and magnesium.
Read about cancer and low calcium levels
Some people find they have a temporary increase in their bone or joint pain. You can control this with a mild painkiller such as paracetamol. Talk to your doctor if this doesn’t improve after a few days.
Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.
Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.
This is usually mild. You can do things to help yourself, including some gentle exercise. It’s important not to push yourself too hard and eat a well balanced diet.
Talk to your doctor or nurse if this effect is stopping you from doing your usual daily activities.
Feeling sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.
You might have some changes in the way your kidneys work. You'll have regular blood tests to check how well they are working.
This can be a side effect of taking bisphosphonate tablets. Tell your doctor if you already have problems with your food pipe (oesophagus) or if you develop new symptoms such as pain or difficulty swallowing.
Take your tablets according to the instructions your doctor or pharmacist gives you. You might be advised to take your tablets on an empty stomach. Or to take your tablets while standing or sitting upright. This is to try and prevent irritation of your food pipe.
Let your doctor know if you have a burning sensation in your lower chest (heartburn).
Osteonecrosis (pronounced oss-tee-oh-neh-kro-sis) means death of bone tissue. Osteonecrosis of the jaw bone can occasionally happen when taking bisphosphonates. The exact causes are not known.
You should have a dental check up before you start treatment. Always tell your dentist that you’re having bisphosphonate therapy or tell your cancer specialist if you need dental treatment.
Read about bisphosphonates and jaw problems
It is important to keep your mouth clean. Talk to your doctor about any mouth problems during treatment.
Find out more about side effects of cancer drugs and how to cope with them
Always follow the instructions your doctor or pharmacist gives you when taking bisphosphonates.
Take the tablets or capsules on an empty stomach, or they won't be absorbed well. Some people find it easiest to take them first thing in the morning and wait at least an hour before eating anything or having any milk.
Drink plenty of fluids to help protect your kidneys. Ask your doctor or nurse about how much they recommend you drink each day.
Bisphosphonates can interact with other drugs you are taking. This includes some painkillers such as non steroidal anti inflammatory drugs (NSAIDs) and antibiotics. Check with your doctor or pharmacist before taking any new medicines.
As bisphosphonates can lower the level of calcium in the blood, your doctor might prescribe you daily calcium and vitamin D supplements. This is only if your calcium level isn’t too high. Vitamin D helps the body absorb calcium.
This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment. Talk to your doctor or nurse about effective contraception before starting treatment.
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Last reviewed: 12 Jun 2023
Next review due: 12 Jun 2026
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Read more about how cancer might affect the calcium levels in your blood and what this could mean for you.
Secondary bone cancer is when a cancer that started in another part of the body has spread to the bones. It is also called bone metastases.
A rare side effect of bisphosphonate treatment is osteonecrosis of the jaw. It happens when healthy bone tissue in the jaw becomes damaged and dies.
There are many cancer drugs, cancer drug combinations and they have individual side effects.
Bisphosphonates are drugs that can help prevent or treat bone loss and reduce the risk of fractures. There are several different types of bisphosphonates, and they each work slightly differently.
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