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This information is about a drug called zoledronic acid that can be used when cancer has spread to the bones.
If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.
Zoledronic acid belongs to a group of drugs called bisphosphonates. Bisphosphonates are commonly used to treat osteoporosis (bone thinning). In certain situations, bisphosphonates can help protect your bones against some of the effects of secondary bone cancer, such as pain and weakness. Secondary bone cancer occurs when the original cancer (the primary) spreads to form a secondary cancer (metastasis) in the bone.
Zoledronic acid is often given alongside other cancer treatments. As well as being used in some types of secondary bone cancer, it has been shown to be effective for people with myeloma (a cancer of the plasma cell of the blood). It is also used to lower a raised calcium level in the blood.
In secondary bone cancer, calcium (which helps to strengthen the bones) can be lost from the damaged bone and can seep into the bloodstream. When the level of calcium in the blood is raised, this is known as hypercalcaemia. It can cause symptoms such as feeling or being sick (nausea or vomiting), tiredness, irritability and sometimes confusion. Zoledronic acid can help to reduce high levels of calcium.
Secondary cancer in the bones may cause them to become weakened, and in some situations they may fracture or break. Zoledronic acid can help to re-strengthen the bone and reduce the risk of fractures.
Cancer can affect the bones in different ways, and zoledronic acid is not helpful for all cancers that affect the bones. Your doctor or specialist nurse can tell you if it would be helpful for you.
In normal bone, two types of cell (osteoclasts and osteoblasts) work together to shape, rebuild and strengthen existing bone:
Myeloma and some secondary bone cancers can produce chemicals that make the osteoclasts work harder. This means that more bone is destroyed than rebuilt, and leads to weakening of the affected bone. This can cause pain and means that the bone can fracture or break more easily.
Zoledronic acid targets areas of bone where the osteoclast activity is high. It helps to bring the balance of osteoclast and osteoblast activity back to normal. This can reduce pain and help to strengthen the bone. It also means that less calcium will be lost from the bones.
Zoledronic acid is given by a drip (infusion) into the vein through a fine tube called a cannula. It is usually given in the outpatient department at the hospital. The infusion takes at least 15 minutes and is given once a month.
If you are having zoledronic acid to reduce pain or to strengthen your bones, you may need to take it for as long as it seems to be working for you.
Zoledronic acid to lower calcium levels is usually given as a single 'one-off' dose.
Each person’s reaction to any medication is different. Most people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is having zoledronic acid.
We have outlined the most common side effects. However, we have not included those that are rare and therefore extremely unlikely to affect you. If you notice any effects that are not listed here, please discuss them with your doctor or nurse.
Increased pain Sometimes pain in the affected bone can temporarily become worse when you first take zoledronic acid. If this happens, your doctor can prescribe pain-relieving medicines for you until this side effect wears off.
Flu-like symptoms including a high temperature, chills and muscle and joint pains can sometimes occur. Let your doctor know if these effects are troublesome. It may be helpful to take mild painkillers.
Drop in calcium levels below normal This is extremely rare and usually only temporary. It is unlikely to cause you any symptoms.
Effect on the kidneys Occasionally, zoledronic acid can affect how the kidneys work. This does not usually cause any symptoms and the effects are mild. Your doctor will check how well your kidneys are working during your treatment by doing blood tests.
Headaches Some people have headaches with zoledronic acid, but this is not common. It is important to drink plenty of fluids. Let your doctor know if you are getting headaches, and they will advise you about what medicines to take.
Feeling sick (nausea) and being sick (vomiting) If this happens, your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce the sickness.
Jaw problems This very rare side effect is called osteonecrosis of the jaw. Osteonecrosis is a condition which means healthy bone dies off in a way that is not normal. This tends to happen more commonly in people that have had dental procedures or teeth removed while taking zoledronic acid. It can result in poor healing of the gums or loosening of teeth. If possible, dental treatment should be avoided while taking zoledronic acid.
It is important to let your dentist know that you are taking zoledronic acid, and to let your doctor know if you need any dental treatment.
You may be asked to take calcium and vitamin D supplements while having treatment with zoledronic acid. Your doctor will advise you if this is necessary.
This section has been compiled using information from a number of reliable sources, including:
For more information please see general bibliography.
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