MULTIPLE MYELOMA KNOWLEDGE CENTER

Bisphosphonate Side Effects

Bisphosphonate side effects are usually mild. Common bisphosphonate side effects include:

  • Fever
  • Fatigue
  • Flu-like symptoms
  • Bone / Muscle pain
  • Stomach problems
  • Anemia
  • Low levels of calcium

The flu-like symptoms along with fever and bone/muscle pain occur in approximately 15% of patients following the first dose. These symptoms usually begin 1-2 days following the first dose and the symptoms persist for approximately 8 12 hours. These symptoms do not continue beyond the first dose except in rare cases.

Rare, but serious side effects include:

  • Kidney problems
  • Osteonecrosis of the jaw (damage to the jawbone)
  • Unusual types of bone fractures

Kidney problems have been seen in patients taking intravenously administered bisphosphonates for long periods of time. The risk of kidney problems may be increased in patients who are taking other drugs that affect the kidney (e.g. Thalomid, non-steroidal anti-inflammatory drugs also known as NSAIDs) or have other conditions associated with kidney problems such as hypertension or diabetes mellitus.

Because of the potential for kidney problems, patients taking bisphosphonates should have a blood test to monitor their kidney function (creatinine levels) prior to each treatment. In addition, other blood tests should be performed periodically

Although it has been recommended that patients with mild or moderately reduced kidney function (renal impairment) receive lower doses of Zometa, there are no clinical trials to support this recommendation. Since zoledronic acid has not been evaluated among patients with severe renal impairment, pamidronate should be used in patients with this condition.

If you develop kidney problems while taking bisphosphonates, your therapy will be stopped temporarily and may be re-started once the problem is resolved.

Another rare, but serious side effect, called osteonecrosis of the jaw (ONJ) has been reported some studies. ONJ is a painful condition that involves damage to the jaw bone. Symptoms of ONJ include pain, swelling, infection of the jaw and exposed bone. ONJ seems to be related to the length of time patients are on bisphosphonates and the type of bisphosphonate. It has been seen more frequently in patients taking Zometa.

The majority of patients who develop ONJ have had recent dental or oral surgery or dental injuries (such as a broken tooth). It is important to maintain good oral health while taking bisphosphonates in order to avoid infections in the jaw that might require surgery impacting the jaw bones.

Keeping Your Mouth Healthy While Taking Bisphosphonates

  • Before taking bisphosphonates, patients should have a comprehensive dental exam and complete major dental work.
  • Practice good daily oral hygiene with brushing, flossing and use of an special type of toothbrush called a proxy brush
  • Schedule regular dental visits and let your dentist know you are receiving bisphosphonates
  • Report all dental problems promptly

Avoid tooth extractions and dental procedures that impact the jawbone unless absolutely necessary. However, procedures such as repair of cavities, root canals, crown placement, and dental cleaning are not associated with a risk of ONJ

If a dental procedure that impacts the jaw bone is required, bisphosphonate therapy should be stopped for 3 months prior to the procedure and should not be re-started until the mouth is completely healed and not in less than 3 months following the procedure

Recently, reports of unusual fractures of the hip bone and bones in the feet have been reported with long term use of these drugs.