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Updated September 2022
Bisphosphonates are medicines used to treat bone diseases such as osteoporosis and Paget’s disease. Zoledronate (brand name Aclasta) and pamidronate (brand name Pamisol) are the most commonly prescribed intravenous bisphosphonates in Australia.
Osteoporosis is a common disease of reduced bone mass that results in fragile and brittle bones that break (fracture) more easily.
Fractures may be painful and restrict a person’s ability to carry out their normal daily tasks. Bisphosphonates reduce the risk of a fracture occurring in osteoporosis.
In Paget’s disease, the accelerated formation of abnormal bone causes deformity and pain. Bisphosphonate medicines can help reduce these symptoms.
For more information about OSTEOPOROSIS see the Healthy Bones Australia website https://healthybonesaustralia.org.au/ or phone Healthy Bones Australia on 1800 242 141.
Bone undergoes constant turnover with old bone breaking down and new bone being formed to take its place. This usually happens in a balanced way. If the cycle becomes unbalanced, bone is broken down faster than it is replaced. This leads to osteoporosis.
Bisphosphonates are medicines that slow or stop the bone breaking down. As a result, bone density may increase over time, so the risk of fracture is reduced.
Since osteoporosis doesn’t usually have any symptoms such as pain (until a fracture occurs) you will not ‘feel’ any immediate benefit from your treatment with bisphosphonates.
If used for Paget’s disease, bone pain may lessen with time. Your doctor will explain the likely benefits for you.
You may be asked to have tests to check the effect of treatment on your bones. For example, a bone mineral density test (DEXA scan) is usually done after one to two years of treatment. This is an X-ray that involves a very small amount of radiation.
Sometimes tests of urine or blood are also used to measure the effects of treatment on bone formation and breakdown.
Bisphosphonate injections are given as a drip (infusion) into the vein. The infusion will take between 20 minutes and two hours depending on the type of bisphosphonate being given and the condition being treated.
After the infusion, you may have to remain at the clinic for up to an hour to monitor for reactions.
Bisphosphonate infusions may be given once a year or up every two-three years or every three months depending on the type prescribed and the condition being treated.
Bisphosphonate injections come in different doses. The dose and how often it is given will depend on the type of bisphosphonate being used and the condition being treated.
It is safe to use most other medicines when you are having bisphosphonate infusions (see Precautions on page 3).
You may be prescribed paracetamol and an anti- allergy tablet on the day of your infusion.
It is generally recommended that you take a calcium and vitamin D supplement.
Osteoporosis treatment with intravenous bisphosphonates is usually given for three to six years. Your doctor will review your progress each year. For Paget’s disease, the treatment plan may be shorter.
Most people who have bisphosphonate injections do not experience side effects. Tell your doctor if you are concerned about possible side effects.
A reduction in dose or change to another medicine may minimise the side effects so that you can continue to have treatment for your bones.
Kidney function and blood calcium levels should be checked before treatment.