Canterbury DHB


Complications of Bisphosphonate Treatment

In This Section

Calcium and Vitamin D Deficiency

Osteonecrosis of the Jaw (ONJ)

Other toxicities

Calcium and Vitamin D Deficiency

If the patient is at risk of calcium or vitamin D deficiency then consider giving calcium and vitamin D. Do not give these drugs if there is hypercalcaemia:

Serum calcium, phosphate, magnesium, creatinine, and vitamin D levels should be measured prior to treatment.

Osteonecrosis of the Jaw (ONJ)

Osteonecrosis of the jaw has been reported in patients with cancer receiving treatment regimens including bisphosphonates. Many of these patients were also receiving chemotherapy and corticosteroids. The majority of reported cases have been associated with dental procedures such as tooth extraction. Many had signs of local infection, including osteomyelitis.

Obtain a dental examination with appropriate preventative dentistry before treatment with bisphosphonates.

Download dental advice for patients prescribed anti-resorptive or anti-angiogenic drugs for the management of cancer.

While on treatment, these patients should avoid invasive dental procedures if possible. For patients who develop osteonecrosis of the jaw while on bisphosphonate therapy, dental surgery may exacerbate the condition. For patients requiring dental procedures, there are no data available to suggest whether discontinuation of bisphosphonate treatment reduces the risk of osteonecrosis of the jaw. Clinical judgment of the treating physician should guide the management plan of each patient based on individual benefit/risk assessment.

ONJ risk may be greatest with zoledronic acid. It appears to be extremely low with the currently available oral bisphosphonates.

See Marx et al J.Oral and Maxillofacial Surgery 2005 for a more detailed account of this problem.

Other toxicities

Drug fever, with or without rigors, very occasionally occur within 48 hours and is transient and self-limiting. The first doses are occasionally associated with an increase in pain. Consider premedication with paracetamol if this occurs.

Rarely – hypertension, hypotension, other electrolyte abnormalities, skin rash, thrombocytopenia, nephrotoxicity, seizures, general fluid overload, hypertension, ototoxicity, headache, constipation, urinary tract infection and anaemia.

About this Canterbury DHB document (7654):

Document Owner:

Amy Holmes (see Who's Who)

Last Reviewed:

September 2014

Next Review:

September 2016


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Topic Code: 7654