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Carole,
Here is an other just reported article on the subject :
Prevention and Management of Side Effects Associated with Bisphosphonates Evaluated
According to an article recently published in the Annals of Oncology, researchers have compiled data and provided suggestions about prevention and management of certain side effects associated with the use of bisphosphonates.

Many patients with advanced cancers experience bone metastases, or spread of cancer to the bones. Bone metastases may ultimately cause debilitating bone pain, bone fractures, spinal compression (a life-threatening condition), and/or abnormalities in calcium levels in the blood; these conditions severely reduce a patient’s quality of life. Treatment for bone metastases is aimed primarily at reducing pain, delaying the time when fractures occur, or reversing hypercalcemia (high levels of calcium in the blood).

Bisphosphonates are a class of drugs used for the treatment of cancer-related hypercalcemia (high levels of calcium in the blood) and of bone metastases in patients with advanced cancers. Bisphosphonates decrease the rate of bone destruction in patients with bone metastases. As well, clinical studies have demonstrated that bisphosphonates can significantly decrease the pain and number of fractures occurring from bone metastases.

The role of bisphosponates has not yet been clearly defined; some researchers believe that bisphosphonates used earlier in the course of cancer may help to prevent bone metastasis. Furthermore, the superiority of one bisphosponate over another has not yet been established. Continuing research is aimed at answering these questions.

Although bisphosphonates are being used in the clinical setting and are being evaluated extensively in clinical trials, the management and risk of side effects associated with their use has not been extensively explored.

Researchers from the H. Lee Moffit Cancer Center and Loyola University recently published suggestions about the management of side effects associated with the intravenous form of bisphosphonates.[*]It is estimated that approximately 2% of patients who receive intravenous bisphosphonates will suffer from serious side effects.

[*]Inflammatory reactions tend to become less frequent with subsequent treatments.
[*]Ocular (eye) inflammation may require therapy to be stopped
[*]Testing of electrolytes should be done prior to administration of therapy.
[*]Patients should undergo a dental exam prior to use of bisphosphonates, as dental problems are associated with a significant increase in the risk of osteonecrosis of the jaw (death of the bone of the jaw).
[*]Patients should not undergo dental procedures while on medication with bisphosphonates.
[*]Monitoring of kidney function should be implemented so that treatment may be discontinued if kidney function becomes abnormal

The researchers concluded that the prevention and/or management of side effects associated with bisphosphonates is important as these agents may provide great relief to patients. Patients should discuss potential side effects and symptoms that may indicate a side effect of therapy; such symptoms should be reported to a healthcare provider.

Reference: Tanvetyznon T and Stiff PJ. Management of the Adverse Effects Associated with Intravenous Bisphosphonates. Annals of Oncology. 2006;17:897-907