WHAT ABOUT SIDE EFFECTS OF BISPHOSPHONATES?

You should discuss your individual circumstances with your doctor, but if bisphosphonate treatment is required, the benefits often outweigh the risk of any potential side effects.

A comprehensive review on the effects of bisphosphonates in the treatment of Paget’s disease, published in 2017, concluded that serious side effects were rare and that the most common side effects experienced were a flu-like illness in people given bisphosphonates by infusion, and stomach upset in those given tablets. Severe side effects causing treatment discontinuation were rare.

The most common side effect with zoledronic acid is a flu-like reaction that lasts a day or two in most people who experience it. It is usually of mild or moderate severity, but more severe reactions can sometimes occur. Pamidronate can also cause a flu-like reaction but there is less information on the frequency with which this occurs or its severity. If a flu-like reaction does occur with either drug, it can usually be controlled with paracetamol or ibuprofen.

Both zoledronate and pamidronate (see below) may cause a decrease in calcium levels. The risk of this is reduced in people who have a good dietary calcium intake and those with normal levels of vitamin D. Sometimes vitamin D levels (25-hydroxy vitamin D) might be measured before treatment to determine if supplements are required. Depending on the results, calcium and vitamin D supplements may be given prior to treatment as a preventative measure.

The most common side effect of taking oral bisphosphonates (risedronate) is stomach upset. 

On rare occasions, bisphosphonates are associated with osteonecrosis of the jaw (ONJ). This is a condition which may present after dental surgery when exposed bone fails to heal. ONJ is rarely seen in those with Paget’s disease and the risk of ONJ is greater if bisphosphonates are given for cancer. As a precaution, however, if possible, complete any extensive dental treatment prior to bisphosphonate treatment. If you have to undergo extensive dental procedures, it is important to inform your dentist that you are having, or have had treatment with a bisphosphonate.

When should bisphosphonates be avoided?

The decision to give treatment may be modified if you have another medical problem which could be aggravated by bisphosphonates. As bisphosphonates are excreted by the kidneys they cannot be used if there is significant kidney disease. If you are being considered for bisphosphonate treatment the doctor will usually organise a blood test to check kidney function, to see if it is safe to go ahead. Although bisphosphonates are rarely given to younger people, they should be avoided during pregnancy as their effects on the foetus are unknown.

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