Side effects of bone-strengthening treatment

You may have side effects from treatment to improve bone density and make your bones stronger. Some of these are rare but can be serious.

Bone-strengthening treatments are bisphosphonates such as Zometa and Aclasta and biologic agents such as Xgeva and Prolia.

Common side effects

• flu-like symptoms
• nausea and vomiting
• heartburn
• diarrhoea
• renal toxicity.

Rare side effects

Hypocalcaemia

‘Hypocalcaemia’ means low levels of calcium in the blood. Bisphosphonates or the biologic agent Xgeva can cause the level of calcium in your blood to fall. Low calcium can cause:

• tingling and numbness of the fingertips and mouth (‘perioral’ area)
• muscle cramps
• twitching or spasm
• anxiety and irritability
• seizures.

To reduce the risk of hypocalcaemia, it’s important you have enough Vitamin D and calcium in your blood.

If your calcium or Vitamin D levels are low when you start bone-strengthening treatment, your risk of hypocalcaemia is higher. Your medical oncologist will arrange a blood test before treatment starts to correct any deficiencies.

During treatment, your doctor will:

• regularly monitor your Vitamin D and calcium levels. They will need to arrange this if you’re being treated with Xgeva through your local clinic, in between seeing your medical oncologist.
• prescribe vitamin D and calcium supplements, if necessary.

Osteonecrosis of the jaw (ONJ)

Osteonecrosis is a rare dental condition. A lower level of blood flow to the bone tissue causes the bone to die. It can affect the jaw or, more rarely, the ear.

If you have persistent jaw pain, swelling, redness or ulcers in the gums, ear pain or ear discharge, tell your specialist.

ONJ can happen after dental procedures such as a tooth extraction, implant, abscess or infection. It can cause:

• ongoing pain
• loss of sensation
• a chronic abscess.

Before and during treatment

Tell your dentist if you are going to be taking bone-strengthening medication.

Before you start treatment, it is important you have a thorough dental examination and any necessary dental work.

To help prevent ONJ, you should:

• have good oral hygiene
• go to the dentist every 6 months for a check-up and teeth clean
• pay close attention to any decay. 

If you are having Zometa or Xgeva, tell your doctor or nurse if you need any dental work. You may need to take a break from the treatment.