Advantages:

• Helping to relieve bone pain
• Many men may have a better quality of life due to less pain and being able to move around more easily
• Controlling and reducing high levels of calcium in the blood
• Possibly reducing the risk of broken bones

Disadvantages:

• Side effects such as feeling sick, tiredness and flu-like symptoms
• Travelling to the hospital every three or four weeks for treatment, if you are having an infusion into a vein

Discuss the advantages and disadvantages with your specialist team to help you decide whether to take bisphosphonates.

There are several bisphosphonate drugs available. Zoledronic acid (Zometa) is used to relieve bone pain in men with prostate cancer. Other bisphosphonate drugs include pamidronate (Aredia) or clodronate (Bonefos, Loron).

Before you start bisphosphonate treatment, tell your doctor if you have ever had any problems with your liver, kidneys, heart, teeth or jaw. You should have a dental check up before your start your treatment. This is to reduce the risk of developing a condition called osteonecrosis of the jaw. (Read more about this in side effects.)

Zoledronic acid and pamidronate are usually given as an infusion into a vein every three to four weeks. Treatment is at the hospital and takes about 15 minutes. Other bisphosphonates may be given as tablets. You should take them on an empty stomach with plenty of water, and wait at least an hour before eating.

You can read more about treatment with bisphosphonates in our online fact sheet.

Side effects will depend on which drug you are taking. You may not get all or any of these.

Common side effects may include:

• An increase in bone pain when you first take the drugs. Pain relieving drugs can help this.
• Flu-like symptoms such as joint, bone and muscle ache, headache, tiredness and raised temperature. Tell your doctor if you have any of these symptoms. They are generally mild and usually last up to 24 hours after treatment. Taking paracetamol can help to relieve them.
• Feeling or being sick or loss of appetite.
• A drop in the level of red blood cells (anaemia) - this may make you look pale and feel weak.
• Rash and itching
• Eye irritation (conjunctivitis)
• Changes in how well your kidneys work. These changes are not usually serious, and are not permanent.

Many of these side effects only last a few days.

Less common side effects include:

• Lowered levels of calcium and other minerals in your body such as potassium and magnesium.
• Irritation of the oesophagus (the tube which food passes down when you swallow) causing inflammation and ulcers. Tell your specialist team if you have any problems swallowing, pain or heartburn.
• Risk of heart problems. One recent study has found that bisphosphonates may slightly increase the risk of heart problems including a fast and irregular heartbeat and stroke. However, more research is needed to show clearly whether this is a side effect of bisphosphonates.
• A rare condition called osteonecrosis of the jaw. It is more common in men who receive bisphosphonates as an infusion than those who take them in a tablet.

You can read more about side effects in our online fact sheet.

• Would you recommend bisphosphonate treatment for me?
• What are the main benefits of bisphosphonates?
• What are the main side effects of bisphosphonates?
• Who do I contact if I have side effects?
• Are there any trials of bone drugs which I can take part in at my own hospital or somewhere else?

References to sources of information used to produce this page:

• Study about bisphosphonates and the risk of heart problems: Wilkinson GS, Baillargeon J, Kuo Y-F, Freeman JL, Goodwin JS. Atrial Fibrillation and Stroke Associated With Intravenous Bisphosphonate Therapy in Older Patients With Cancer. Journal of Clinical Oncology. 2010;28(33):4898-905.

You can find a list of references used to produce this page in our online fact sheet.