Ask the Nurse: Bisphosphonates

Bisphosphonates are a group of drugs central to treating and preventing myeloma bone disease, and bone pain.

Myeloma bone disease, when bones become thinner, weaker, and more prone to breaks, is one of the most common features of myeloma and can have a huge impact on day-to-day life. Bisphosphonates are given to slow down or prevent bone breakdown.

In this month’s blog, we look at some of the most common questions people ask us about bisphosphonates.

What are bisphosphonates?

Bisphosphonates are a type of drug used to help to protect against some of the effects of myeloma bone disease.

Myeloma bone disease affects the normal maintenance of healthy bone, causing bone to be broken down faster than it is renewed. This can cause small holes in the bones, weakening it, which can lead to pain and mobility issues. In rare cases, serious complications can occur such as spinal cord compression.

Preventing or slowing down myeloma bone disease is, therefore, very important for managing your quality of life.

What are the most common side effects, and how are they managed?

Most people tolerate bisphosphonates well, but you might experience some mild side effects. These could include:

• Mild fever and flu-like symptoms – paracetamol can help manage these side effects
• Feeling sick – you can ask for anti-sickness drugs
• Indigestion – your healthcare team can offer support for these symptoms
• Kidney problems – you will have regular blood tests so your healthcare team can keep an eye on how well your kidneys are working
• Jaw problems – a less common but serious complication can be damage to the jawbone, known as osteonecrosis of the jaw (ONJ). You will need to work with your healthcare team and your dentist to reduce your risk both before and throughout bisphosphonate treatment. Find out more in our ONJ Infosheet.

It is important to report any side effects to your doctor or nurse so they can be treated or managed promptly.

Use your Patient Diary to record how your symptoms and side effects impact you. This can help you have open conversations with your healthcare team and help them find the right solutions for you.

How long do I need to stay on bisphosphonates?

It’s currently recommended that all myeloma patients who need treatment for their myeloma receive bisphosphonates, even if they don’t have signs of myeloma bone disease. This is because bisphosphonates can prevent new damage occurring as well as slow down existing bone breakdown.

You will likely receive bisphosphonates for a minimum of two years following diagnosis and again at relapse.

How do bisphosphonates help me?

The most important way to treat myeloma related bone damage is to treat and reduce the bulk of the myeloma. However, bisphosphonates are used as a supportive treatment which can help by:

• Slowing down or preventing bone breakdown
• Reducing bone pain
• Reducing the need for painkillers
• Preventing and correcting high calcium levels
• Reducing the need for radiotherapy
• Reducing the likelihood of fractures due to myeloma bone disease

Bisphosphonates cannot repair bone damage that has already happened, but they can prevent future damage from occurring. However, there are other treatments which can help to manage the effects of earlier bone damage, such as painkillers and radiotherapy for ongoing pain.

How do bisphosphonates work?

Figure 1. Bisphosphonates reduce the activity of the cells which break down bone, known as osteoclasts. This leads to less bone breakdown

What are the different types of bisphosphonates?

Three bisphosphonate treatments are currently available on the NHS in the UK. These include:

• Zoledronic acid (Zometa^®) – most newly diagnosed patients will be offered this treatment
• Disodium pamidronate (Aredia^®)
• Sodium clodronate (Loron^®, Clasteon^®, Bonefos^®)

All these bisphosphonates are effective in treating myeloma bone disease. However, some may be more potent or have different side effects. Your healthcare team will work with you to find the best treatment for you.

Can I have bisphosphonate treatment at home?

Zoledronic acid and disodium pamidronate are given by intravenous infusion (into a vein). This usually means that you will need to visit a hospital regularly to have your treatment through a drip.

Some patients may prefer sodium clodronate because it is given as an oral tablet, taken once or twice a day.

Although this does remove the need for regular hospital visits for bisphosphonate treatment, remember that different bisphosphonates may be more effective or more suitable for you than others, as myeloma is an individual cancer.

It is important to consider all aspects with your healthcare team to make sure the right treatment is chosen for you and your circumstances.

I don’t have bone problems; can I stop having bisphosphonates?

No, you should not stop any treatments without talking to your healthcare team first.

Sometimes, patients may feel unsure about continuing bisphosphonate treatment. If you haven’t experienced any myeloma bone disease, you might feel the treatment isn’t necessary for you. However, it is important to have them to prevent any future bone damage.

If you are struggling with side effects or finding it frustrating visiting the hospital regularly for treatment (especially if you otherwise feel well), talk things through with your healthcare team. They will be able to clarify things for you and discuss any decisions about your treatment and care.

They will also be able to suggest solutions to manage any side effects you may be having. Sometimes you might be able to take a break from treatment, or adjustments could be made to your treatment that makes it easier to manage. Adding other supportive care to help with some side effects may also be an option.

You can read more about bisphosphonates and myeloma bone disease in our Myeloma bone disease Infoguide or watch our Myeloma bone disease Digital Infoday Session. You can find more information on coping with the complications of myeloma in our Infopack for living well with myeloma and our Psychological wellbeing and myeloma Digital Infoday Session.

Get in touch with us through the Myeloma Infoline on 0800 980 3332 (UK) or 1800 937 773 (Ireland) or by using the Ask the Nurse email service.