Bisphosphonates are drugs that can help manage bone pain when prostate cancer has spread to the bones. If cancer spreads to your bones, it may damage and weaken them. This can cause bone pain and increase your risk of broken bones.


Your bones are made of living tissue and are constantly changing. In healthy bones, cells are always breaking down and rebuilding bone tissue - this is called the bone cycle. When prostate cancer spreads to the bone, it upsets the careful balance between the breakdown of old bone and the building of new bone.


Bisphosphonates help to prevent the breakdown of bone and encourage bone building in places where too much bone has been broken down. This can help to relieve pain. Bisphosphonates can also be used to treat a condition called hypercalcaemia, which is high levels of calcium in the blood.


In some hospitals, bisphosphonates might also be used to manage bone thinning caused by hormone therapy, or to help prevent and slow down further bone damage. For more information about bone thinning in prostate cancer, read our pages about living with hormone therapy.


What other treatments are available?

Who can have bisphosphonates?

If you live in England or Wales, you may be offered bisphosphonates if your prostate cancer has spread to your bones. This is called advanced or metastatic prostate cancer. Prostate cancer that has spread to the bones is not the same as bone cancer, which starts in the bones.

In Scotland and Northern Ireland, bisphosphonates are not widely available for men with prostate cancer. If you live in Scotland, speak to your doctor about whether you can be given bisphosphonates. If you live in Northern Ireland, you may have to send an Individual Funding request to your local health board to get permission to have bisphosphonates. Talk to your doctor or nurse about what treatments you can have to manage your bone pain or any other problems you are have with your bones.

What are the advantages and disadvantages?

As with all drugs, there are pros and cons of using bisphosphonates. Talk to your doctor or nurse about your own situation.



  • Bisphosphonates help to relieve bone pain and stop it getting worse.
  • You may find it easier to move around if you have less bone pain.
  • Bisphosphonates may help to reduce your risk of broken bones and other bone problems.
  • Bisphosphonates can lower the amount of calcium in your blood if it is high (hypercalcaemia) and treat the symptoms of this.


  • Like all treatments, bisphosphonates can cause side effects.
  • If you're having zoledronic acid you may have to travel to the hospital every three or four weeks for treatment.
  • Bisphosphonates for bone pain are given through a drip into a vein (also called an infusion), which can be uncomfortable but not painful.
  • Bisphosphonates can take up to three months to start helping with bone pain.
  • You may need to have regular dental check-ups.

What does treatment involve?

Bisphosphonates are liquid medicines that are given through a drip in the vein. Each treatment takes about 15 minutes. Each hospital and doctor will do things slightly differently, so you may have a treatment every three to four weeks. the most common bisphosphonate drug given to men with advanced prostate cancer is called zoledronic acid (Zometa®).


Before each treatment, you will have some tests to check your kidneys. This is because bisphosphonate drugs may affect how well the kidneys work. You'll also have regular blood tests to check you have the right amount of calcium, magnesium and phosphate (minerals to build new bone) in your blood.


You might need to have a full dental check up before you start treatment. This is to lower the risk of developing a condition called osteonecrosis of the jaw.


Speak to your doctor or nurse about any medical or dental problems you've had in the past. And let them know about any medicines you are taking at the moment.

What are the side effects?

Like all medicines, bisphosphonates can cause side effects. These can vary from person to person. Some of the possible side effects are listed below.


Common side effects:

If you get any of the following side effects, tell your doctor or nurse. They can usually suggest treatments or ways to manage them.

Flu-like symptoms

This usually only lasts around 24 hours and should go away after the first or second treatment. Tell your doctor or nurse if you have this. They may recommend pain-relieving drugs such as paracetamol to help manage this.


Feeling sick (nausea) and being sick (vomiting)

You may feel or be sick after having bisphosphonates. This shouldn't last for more than a few days. If it does carry on, your doctor or nurse can give you anti-sickness medicines which will help.


Loss of appetite

You may feel less hungry after having treatment. This should improve in a few days, but it is important to drink plenty and eat healthily while you are having bisphosphonates.


Increased pain

Some men may get slighly more joint, muscle or bone pain when using bisphosphonates. Pain-relieving drugs can help until the pain improves. Speak to your doctor or nurse if the pain doesn't improve after a few days.


Low blood calcium and phosphate levels

Bisphosphonates can cause the levels of minerals in your blood, such as calcium and phosphate, to become too low. Your doctor or nurse will check this regularly and give you supplements if you need them.


Kidney problems

Bisphosphonates can change how well your kidneys work. You will have regular tests to check this. In those cases, these changes may not be serious, and your kidneys will return to normal if you stop using bisphosphonates.


Red or sore eyes (conjunctivitis)

Your eyes may feel itchy, sore or dry. Your doctor or nurse can prescribe eye drops to help with this.


Less common side effects:

If you get any of these side effects, tell your doctor or nurse. They can usually suggest treatments or ways to manage them.

Rash or itching

You may notice a rash on your skin or feel quite itchy. This can be uncomfortable but shouldn't last for more than a few days.


Stomach or bowel problems

You may feel stomach pain or notice changes in your bowel habits. For example, you may have loose and watery stools (diarrhoea).Or you may find it hard to empty your bowels (constipation). This shouldn't last more than a few days.


Risk of heart problems

Bisphosphonates may slightly increase your risk of heart problems (including a fast and irregular heartbeat) and stroke. Talk to your doctor about this if you're worried about it, or if you've had heart problems before.


Jaw problems (osteonecrosis of the jaw)

Osteonecrosis of the jaw is a rare side effect. It happens when the healthy bone in the jaw becomes damaged and dies. Keeping your teeth and mouth clean may help to lower your risk of getting osteonecrosis of the jaw. Ask your dentist if you have any questions about this.

Questions to ask your doctor or nurse

  • Are bisphosphonates suitable for me?
  • How long will I be given the drug?
  • What are the main benefits of bisphosphonates?
  • What are the main side effects of bisphosphonates?
  • Who do I contact if I have side effects?
  • Am I likely to get osteonecrosis of the jaw?
  • What other drugs are available to treat bone pain?


  • Full list of references used to produce this page  

    This publication was written and edited by:

    Prostate Cancer UK's Information Team

    It was reviewed by:

    • Lawrence Drudge-Coates, Urological Oncology Clinical Nurse Specialist and Honorary Lecturer, King's College Hospital NHS Foundation Trust, London
    • Rob Jones, Senior Lecturer and Honorary Consultant in Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow
    • Philip Reynolds, Advanced Urological Practitioner, Cancer Outpatients Clinic, Guy's and St. Thomas' Hospital, London
    • Bruce Turner, Uro-oncology Nurse Practitioner, Homerton University Hospital and Bart's Health, London
    • Deborah Victor, Urological Oncology Clinical Nurse Specialist, Royal Cornwall Hospitals Trust, Truro
    • Cathryn Woodward, Consultant Clinical Oncologist, West Suffolk Foundation Trust Hospital, Bury St Edmunds
    • Prostate Cancer UK Specialist Nurses
    • Prostate Cancer UK Volunteers


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