What to know about intravenous bisphosphonates

Bone is continually renewed. Bisphosphonates attach to bone and reduce the activity of cells that remove old bone. In oncology, this can help limit bone weakening linked to myeloma, cancer in the bones or some cancer treatments. These medicines may also be used when cancer has caused too much calcium to move from bone into the blood.

The medicine is delivered through a cannula into a vein. The exact drug, infusion schedule and length of treatment depend on why it is being used, kidney function and the rest of your cancer plan.

Your team will arrange blood tests to check kidney function and mineral levels such as calcium. Tell them about kidney problems, pregnancy, medicines and supplements, and any planned dental work. Have dental problems assessed before treatment when possible, and tell your dentist that you receive an intravenous bisphosphonate.

Follow your clinic's advice about drinking fluids and taking calcium or vitamin D; supplements are not suitable for everyone. Aching muscles or joints, headache, tiredness, nausea, fever or flu-like feelings can occur after an infusion. Ask the treatment team which pain or fever medicine is appropriate for you, because some over-the-counter medicines may not suit your kidneys or cancer treatment.

Contact your cancer team promptly if you develop a fever or feel acutely unwell, especially if you are also receiving treatment that can lower infection-fighting blood cells. Report passing much less urine, persistent vomiting, worsening weakness, muscle cramps, tingling around the mouth, or new eye pain or visual changes.

Tell the team and your dentist about jaw pain, swelling, loose teeth, a mouth sore that does not heal, or exposed bone. Seek emergency help for trouble breathing, swelling of the face or throat, faintness, or another sign of a severe allergic reaction during or after the infusion.

Ask which bisphosphonate you are receiving, what it is intended to do in your care, and how the team will judge whether to continue it. Confirm when blood tests are due, whether you need calcium or vitamin D, what to do if you need a tooth removed, and whom to call if side effects begin outside clinic hours.