General side effects of bisphosphonates and denosumab

Bisphosphonates are drugs that help prevent or slow down bone thinning (osteoporosis). They can help to treat some types of cancer that cause bone damage.

Doctors also use a drug called denosumab as a bone targeted treatment. It’s a type of targeted therapy called a monoclonal antibody.

Possible side effects

Bisphosphonates don’t usually cause too many side effects. They tend to be mild if you do have them. Everyone reacts differently to drugs and you may have one or more side effects.

Fever and flu-like symptoms

This is more common when you have the bisphosphonate as a drip (infusion) rather than bisphosphonate tablets. Symptoms usually last for a few hours. Taking painkillers like paracetamol can help.

Talk to your doctor or advice line if you have a fever or flu-like symptoms.

Low levels of calcium in your blood (hypocalcaemia)

You will have blood tests to check the levels of calcium and other minerals such as potassium and magnesium.

Bone and joint pain 

Some people find they have a temporary increase in their bone or joint pain. You can control this with a mild painkiller such as paracetamol. Talk to your doctor if this doesn’t improve after a few days.


Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Lack of energy and strength

This is usually mild. You can do things to help yourself, including some gentle exercise. It’s important not to push yourself too hard and eat a well balanced diet.

Talk to your doctor or nurse if this effect is stopping you from doing your usual daily activities.

Feeling sick (nausea)

Feeling sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Kidney changes

You might have some changes in the way your kidneys work. You'll have regular blood tests to check how well they are working.

Irritation of the food pipe (oesophagus)

This can be a side effect of taking bisphosphonate tablets. Tell your doctor if you already have problems with your food pipe (oesophagus) or if you develop new symptoms such as pain or difficulty swallowing.

Take your tablets according to the instructions your doctor or pharmacist gives you. You might be advised to take your tablets on an empty stomach. Or to take your tablets while standing or sitting upright. This is to try and prevent irritation of your food pipe.

Let your doctor know if you have a burning sensation in your lower chest (heartburn).

Jaw problems 

Osteonecrosis (pronounced oss-tee-oh-neh-kro-sis) means death of bone tissue. Osteonecrosis of the jaw bone can occasionally happen when taking bisphosphonates. The exact causes are not known.

You should have a dental check up before you start treatment. Always tell your dentist that you’re having bisphosphonate therapy or tell your cancer specialist if you need dental treatment.

It is important to keep your mouth clean. Talk to your doctor about any mouth problems during treatment.

Important information

Always follow the instructions your doctor or pharmacist gives you when taking bisphosphonates. 

Food and drink

Take the tablets or capsules on an empty stomach, or they won't be absorbed well. Some people find it easiest to take them first thing in the morning and wait at least an hour before eating anything or having any milk.

Drink plenty of fluids to help protect your kidneys. Ask your doctor or nurse about how much they recommend you drink each day.

Other medicines

Bisphosphonates can interact with other drugs you are taking. This includes some painkillers such as non steroidal anti inflammatory drugs (NSAIDs) and antibiotics. Check with your doctor or pharmacist before taking any new medicines.

As bisphosphonates can lower the level of calcium in the blood, your doctor might prescribe you daily calcium and vitamin D supplements. This is only if your calcium level isn’t too high. Vitamin D helps the body absorb calcium.

Pregnancy and Contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment. Talk to your doctor or nurse about effective contraception before starting treatment.

Read more about:

More information

Find your drug on our cancer drug A-Z list to get more information, including side effects.

  • Electronic Medicines Compendium
    Accessed June 2023

  • Bisphosphonates use and safety
    Medicines and Healthcare Products Agency, 2014 (Accessed June 2023)

  • Prostate cancer: diagnosis and management
    National Institute for Health and Care Excellence (NICE), 2019 (updated 2021)

  • Early and locally advanced breast cancer: diagnosis and management
    National Institute for Health and Care Excellence (NICE), 2018 (updated 2023)

  • Myeloma: diagnosis and management
    National Institute for Health and Care Excellence (NICE), 2016 (updated 2018)

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact with details of the particular issue you are interested in if you need additional references for this information.

Last reviewed: 
12 Jun 2023
Next review due: 
12 Jun 2026

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