Complications of Bisphosphonate Treatment

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.

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
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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