Bisphosphonates for metastatic cancer

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Bisphosphonates for metastatic cancer


Generic NameBrand Name
zoledronic acidZometa

Pamidronate and zoledronic acid are given in IVs (intravenously) to treat cancer that has spread to the bone. Usually treatment is needed only once a month.

How It Works

Cancer cells that have spread to the bone upset the normal cellular activity in the bone. Bisphosphonates slow the activity of these cancer cells and help to reduce the breakdown of the bone. This relieves pain and helps keep bones from breaking.

Why It Is Used

Bisphosphonates are used to treat bone pain caused by cancer that has spread to bone (bone metastasis). They also help reduce pain from cancers that begin in the bone, such as multiple myeloma.

How Well It Works

Bisphosphonates decrease fractures and relieve bone pain in people who have multiple myeloma or cancer that has spread to the bones.1

Side Effects

Side effects of bisphosphonates can include:

  • Abdominal pain, heartburn, or increased gas.
  • Nausea.
  • Diarrhea or constipation.
  • Flu-like symptoms, including headache and muscle or joint pain.

Possible side effects that can occur but are not common include:

  • Increased bone pain. This tends to be related to the amount used.
  • The slowing of new bone growth. Lowering the amount used may reduce this side effect.

Some people taking bisphosphonates have problems with bone decay or delayed bone healing, particularly in the jaw.2 If you are taking bisphosphonates and need dental surgery, talk with your doctor about the risk of problems with bone healing.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Your doctor may suggest that you take calcium and vitamin D supplements while taking bisphosphonates to help keep your bones strong. But be sure to talk with your doctor before taking a vitamin or mineral supplement, because some minerals can interfere with the way these drugs work.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.



  1. Foley KM, Abernathy A (2008). Management of cancer pain. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology, 8th ed., vol. 2, pp. 2757–2790. Philadelphia: Lippincott Williams and Wilkins.
  2. Woo S-B, et al. (2006). Systematic review: Bisphosphonates and osteonecrosis of the jaw. Annals of Internal Medicine, 144(10): 753–761.


By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Michael Seth Rabin, MD - Medical Oncology
Specialist Medical Reviewer Andrew Swan, MD, CCFP, FCFP - Family Medicine
Last Revised May 6, 2010

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