Bone-strengthening drugs

• To help prevent or treat bone damage from cancer that has spread (metastatic cancer).
• Help to reduce pain from cancer that has spread to the bone.
• Slow the growth of cancer in the bone.
• Prevent further bone loss and strengthen the bone to reduce the risk of bone damage, like fractures.
• Lower calcium levels in your blood if they are too high (hypercalcaemia). This can improve symptoms of hypercalcaemia such as nausea, constipation and drowsiness. 
• To treat patients with an early cancer diagnosis who are also suffering from bone loss and need cancer treatments. 
• To slow down or prevent multiple myeloma and secondary cancers in the bone. Cancer cells appear to be attracted to areas where bones are being broken down. It is hoped that stopping this process could slow the growth of cancer and help people live longer, as well as reducing bone damage.

Bisphosphonates are commonly given into a vein in a drip, which can take from 15 minutes up to 3 hours. The treatment may be given every 3 to 4 weeks. Some are given as an injection just below the skin (subcutaneously).

Bisphosphonates can also be given in tablet form. The tablets are taken daily or weekly and are best absorbed on an empty stomach. Certain medications such as antibiotics can affect how they are absorbed. It is important to get instructions from your doctor or pharmacist before taking them.

If you have been prescribed bone-strengthening drugs to strengthen your bones or reduce pain for metastatic cancer, your doctor will decide how long you should continue to take them for, based on how well they are working.

If you are taking a medication to improve bone strength while on hormone therapy for cancer, you may be advised to take it for a number of years.

If you are prescribed bone-strengthening drugs with other treatments such as chemotherapy or as part of a clinical trial, treatment may be for a shorter time.

Bisphosphonates can cause flu-like side-effects. They can also affect your kidneys, so your doctor will need to monitor this for you.

Denosumab can cause nausea and diarrhoea.

A rare side-effect of these drugs is osteonecrosis of the jaw. This is when healthy bone tissue in your jaw dies. You should have a dental check-up before you start treatment. Your doctor or nurse will discuss this with you in more detail and give you tips on looking after your mouth and teeth during treatment.

Tell your doctor or dentist immediately if you develop any problems
with your teeth or gums, or swelling, pain, heaviness or numbness in
your jaw.