Bones are made of living tissue and is constantly updated. Different cell types are working to ensure the reconstruction. Osteoblasts create new bone, osteoclasts break down and remove the old one. This process is called remodeling and controlled precisely. There is a balance between the rate of bone decay and its growth to the bones remain strong and healthy.

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The use of bisphosphonates in Israel

These drugs stop the bone loss process. They contribute to their strengthening. Also drugs are for These bisphosphonates Used to protect the bone Against Certain types of cancers and OTHER Diseases. Some methods - hormonal therapy andchemotherapy - are also able to relax the body.

The most common types of cancer affecting the bone:

  • myeloma;
  • breast cancer;
  • prostate cancer;
  • lungs' cancer.

Since bisphosphonates slow down the destruction of the bone tissue, they can be used:

  • To alleviate bone pain caused by multiple myeloma or metastatic disease.
  • Reduce high blood calcium (hypercalcemia).
  • Strengthen bones and reduce the risk of fractures caused by cancer metastasis or osteoporosis.

This treatment can stop the propagation of certain types of cancerto the bone in some cases. According to the research, sometimes bisphosphonates in multiple myeloma, secondary breast cancer and prostate cancer increases survival.

These drugs are usually used in conjunction with other methods of cancer treatment.

Bisphosphonates with bone metastases

Multiple myeloma, and some types of secondary malignant tumors such as breast cancer or prostate cancer, can penetrate into the bone to metastases. Cancer cells have affected bone, synthesized proteins, impeding the remodeling process. They are called cytokines or growth factors.

Proteins stimulate cells - osteoclasts that destroy bone, transforming them into hyperactive. Thus, the bone breaks down faster than restored. As a result, they will become thinner and weaker, causing the following symptoms:

  • Pain in the affected bone.
  • High levels of calcium.
  • Increased risk of fractures.

And metastases, and multiple myeloma can cause bone pain. Bisphosphonates slow the disintegration of tissue, reducing the symptom. Prescribers often along with other drugs - non-steroidal antiinflammatory drugs (NSAIDs).

Bisphosphonates are targeting the areas where increased rate of remodeling. Osteoclasts absorb the drug, which slows down their activity and reduces the risk of fracture.


When cancer spreads to the bones, or cause their destruction, calcium moves into the bloodstream. This increases its content in the blood. This condition is called hypercalcemia, its symptoms:

  • The feeling of thirst.
  • Constipation.
  • Nausea.
  • Drowsiness.
  • The weakness and fragility of bones.

Bisphosphonates treat hypercalcemia, slowing the decay of bone tissue.

Bisphosphonates for osteoporosis

Bone loss (or density) is called osteoporosis, which causes the body weakness and becomes a cause of the increased risk of fracture. There are many factors likelihood of developing this disease, including some cancer therapies, for example, long-term use of corticosteroids, hormone replacement therapy and some cytostatic drugs. Osteoporosis can also be caused by age and other factors not related to oncology.

Bisphosphonates are used to prevent and treat osteoporosis.

classification of bisphosphonates

Different types of these drugs are used for treatment of bone metastases, and each has its own characteristics in the work. Doctors are studying the mechanism of action of bisphosphonates. It is known that:

  • Bisphosphonates interfere with the process of creation of osteoclasts.
  • Osteoclasts are programmed to self-destruct or early death.
  • Change signals between osteoclasts and osteoblasts.
  • Form a barrier between the bone and osteoclasts.

Researchers have found that bisphosphonates can prevent or slow the development of myeloma and secondary bone tumors in some people. Cancer cells appear to be attracted to the area where the broken bone. Scientists hope that stopping this process is able to slow the progression of the disease and help people live longer, and reduce bone damage.

The choice of drugs caused tumor views. It is used:

  • Clodronate (Bonefos)
  • Pamidronate (Aredia)
  • Zoledronic acid (Zometa)
  • Ibandronate (Boniva).

List of drugs bisphosphonates in oncology

Pamidronate (Aredia)

Doctors in Israel Aredia prescribed for the treatment of cancer, which destroys bone cells or for treatment of bone metastasis:

  • myeloma;
  • with secondary breast cancer;
  • in secondary prostate cancer.

Also, the drug is used for hypercalcemia caused by tumor.

Pamidronate is administered intravenously via cannula, central venous catheter, portacath or PICC line system. The procedure lasts from one to several hours duration caused dose.

To reduce the level of calcium in the blood treatment is carried out every 3-4 weeks, to prevent or reduce damage to the bone.

During therapy regularly conduct blood tests in order to check the amount of calcium in the blood, and urine tests - for the study of the heart and kidneys.

Common possible side effects:

  • Symptoms of the flu.
  • Hypocalcemia.
  • Drowsiness and dizziness.

Rarer potential undesirable consequences:

  • Nausea.
  • Stomach ache.
  • Pain in the muscles and joints.
  • Insomnia.
  • Skin rashes.
  • Problems with kidney function.
  • Headache.
  • Decrease in platelets, anemia.
  • Inflammation and redness of the eyes.
  • Loss of appetite.
  • Pain in the bones.
  • Constipation or diarrhea.
  • Jumps in blood pressure.
  • Osteonecrosis.
  • Arrhythmia.

Drugs bisphosphonates: Ibandronate (Boniva)

It is used to prevent bone problems when their condition weakened cancer. In most cases the indication is secondary breast cancer, also assigned to hypercalcemia.

The drug enters the body in the form of tablets or intravenously. Ibandronate take a full glass of water on an empty stomach after 6 hours after ingestion. follow the instructions is very important to be clear.

Ibandronic acid may also enter intravenously via a cannula, catheter or port-system PICC line system. If the indication is to reduce the level of calcium - the procedure takes one hour to 2. When there is a goal - to prevent or reduce damage to the bones - 15 minutes every three - four weeks.

In the treatment according to preparations in the body should be normal levels of vitamin D and calcium. If there is a flaw, appointed supplements.

Before the start of therapy and during its regular blood tests, which determine the amount of calcium in the blood, studying liver and kidney.

Among the common possible side effects of note:

  • fever;
  • hypocalcemia;
  • irritation of the esophagus;
  • decreased skin sensitivity;
    headache or dizziness;
  • Bone pain at the beginning of therapy.

Among the rare potential adverse effects emit:

  • leukopenia;
  • oral thrush;
  • nausea;
  • abdominal pain;
  • stomach upset;
  • taste changes;
  • cataracts;
  • changes in the level of parathyroid hormone;
  • disorders of the heart;
  • bruising;
  • diarrhea;
  • inflammation of the bladder or vagina;
  • flu symptoms, and others.

Drugs bisphosphonates: Clodronate (Bonefos)

Israeli doctors it is used to treat symptoms of cancer affecting the bone, most commonly in myeloma and secondary breast cancer. The drug is aimed at the elimination of:

  • hypercalcemia;
  • osteolytic lesions;
  • pain in the bones.

It is taken in pill or capsule form.

Common possible undesirable effects of therapy include:

  • diarrhea;
  • nausea;
  • stomach upset;
  • hypocalcemia;
  • malfunction of the liver.

Among the rare potential side effects emit:

  • irregularities in the kidney;
  • wheezing and coughing;
  • osteonecrosis;
  • redness and peeling of the skin;
  • fractures of the femur, and others.

Bisphosphonates Formulations: Zometa (zoledronic acid)

Zoledronic acid reduces the risk of fractures in myeloma, secondary breast cancer and prostate, eliminates hypercalcemia.

The drug is attached to the bone cells and slows the rate of change in bone tissue.

Zoledronic acid is administered intravenously. If the main task - to prevent damage to the bone, the drug is administered every 3-4 days. May require calcium supplementation and vitamin D. When the treatment is aimed at eliminating hypercalcemia medication is designated as a single treatment.

During therapy, regular blood tests to check the number of blood cells and other substances in the blood in order to study the liver and kidneys.

Among the possible adverse consequences of release:

  • flu-like symptoms;
  • hypocalcemia;
  • nausea;
  • loss of appetite;
  • anemia;
  • conjunctivitis.

For more rare potential side effects include:

  • bone pain;
  • pain in the stomach;
  • difficulty sleeping;
  • changes in mood;
  • irregularities in the kidney;
  • changes in blood pressure;
  • constipation or diarrhea;
  • allergic reactions;
  • dizziness, drowsiness, fatigue and so on.

bisphosphonate drugs for osteoporosis

Medications that are used for the prevention and treatment of osteoporosis:

  • alendronate (Fosamax);
  • risedronate (Actonel);
  • etidronate (Didrocal, Didronel).

How is the treatment in Israel?

Bisphosphonates enter the body in two ways. They may be orally administered or administered intravenously.

Admission is carried out once or twice a day on an empty stomach. You must wait at least 30 minutes before eating the food, beverage or any medications, including vitamins and mineral supplements. Tablets and capsules bisphosphonates are poorly absorbed when taken with food or milk, for example.

How many need to be treated with bisphosphonates?

Intravenous treatment is usually carried out every 3-4 weeks. The procedure lasts from 15 minutes to 4 hours depending on the type of bisphosphonate. It can be carried out in a hospital or at home by a nurse.


When the drugs are prescribed to alleviate pain in bones caused by metastasis, the doctor assesses how it has decreased and whether under control. Bisphosphonates may affect the kidneys, so regularly check their work.

If drugs are used to treat hypercalcemia, the doctor sets the level of calcium in the blood, to see if it has decreased, also determines how the patient responds to treatment. A study of the kidneys.

When using bisphosphonates for the prevention and treatment of osteoporosis test is performed to determine bone mineral density to test the body's response to the medication. The doctor evaluates the level of pain and weakness of the bones. We study the functioning of the kidneys.

Possible side effects of bisphosphonates

Undesirable effects characteristic of any type of treatment, but they do not occur in every patient, in addition, the experience is unique. Patients respond differently to medications, however there may be one or more of the symptoms described below.

As a rule, bisphosphonates do not cause a large number of negative effects of therapy. If they arise, they are quite moderate.

Side effects of bisphosphonates are mainly due to:

  • specific drug;
  • its dose;
  • duration of therapy;
  • route of administration in the body - orally or intravenously;
  • general state of health of the person.

It is important to inform the doctor about any symptoms. If these effects are severe, the dose is adjusted.

Below are the most common undesirable effects. Patients may experience all of these effects, some of them or none.

Increased pain in the bones

Sometimes temporary pain intensified at the beginning of bisphosphonates. The patient is prescribed a strong analgesics.


Weakness may occur when taking certain types of bisphosphonates, but usually in a mild form.

Digestive problems

Irregularities in the digestive tract occur more frequently when administered orally:

  • nausea;
  • heartburn;
  • vomiting;
  • stomach cramps or pain;
  • diarrhea or constipation.

These side effects often manifest in a rather mild form, they are controlled by medication. It is important to drink plenty of fluids (6 to 8 glasses a day). Bisphosphonates are administered in two doses - in the morning and evening. Also recommended for 1-2 hours after administration not lie. In rare cases, doctors reduce the dose of drugs to relieve digestive problems.

Bisphosphonates may interact with other medicines, including some analgesics - nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotics. It is important to consult with your doctor before taking other medicines.

flu symptoms

Flu-like symptoms may occur shortly after drug administration:

  • fever;
  • muscle and joint pain;
  • headache.

These adverse effects are rare. Usually occur within the first 24-48 hours after intravenous administration of bisphosphonates. Your doctor may prescribe Tylenol to alleviate these symptoms.

A low level of calcium (hypocalcemia)

Bisphosphonates are able to calcium levels in the blood below normal. This is a very rare side effect, mostly temporary. Doctors prescribe tests checking its level during the present treatment, other minerals - potassium and magnesium.

Changes in kidney function

Bisphosphonates may affect the functioning of the body. It happens in rare cases, and often in a mild form. In most cases, this condition does not cause any symptoms. Doctors prescribe blood tests to check the condition of the body in the course of therapy.

It is important to drink plenty of fluids because it helps to protect the kidneys. The doctor will recommend how much should be consumed daily.


It happens that some bisphosphonates are the cause of a skin rash. It should tell your doctor about this symptom, especially if there is shortness of breath.

Bisphosphonates with osteonecrosis of the jaw

Osteonecrosis is bone death caused by poor blood supply to a certain area. Osteonecrosis of the jaw is a side effect of certain bisphosphonates. It occurs in a very small number of people who were treated with intravenous zoledronic acid (Zometa) and pamidronate (Aredia). This complication is rarely seen in those who take drugs orally.

Osteonecrosis can cause:

  • loosening teeth;
  • pain in the jaw;
  • problems with chewing;
  • Feel jaw gravity.

There are many factors that increase the risk of osteonecrosis. Currently, more research is necessary to find out how bisphosphonates bring this side effect, and how it can be prevented. Osteonecrosis develops more frequently with zoledronic acid and pamidronate for many months - longer than a year.

If the patient needs to take bisphosphonates for a long time, you should meet with your dentist before treatment. Then go to this doctor on a regular basis, every 3 months, for example, to check for these problems.

It is important to take bisphosphonates exactly according to your doctor's instructions. These drugs can cause harm to the developing baby. Therefore, in this period is necessary to prevent pregnancy. Should discuss contraception with your doctor before starting treatment if necessary.

What questions can ask the doctor in the Israeli clinic?

  • As bisphosphonates help me?
  • Are there other options for treatment in my case?
  • In what form will be assigned to bisphosphonates - in the form of tablets, capsules or intravenously?
  • Are these drugs safe?
  • What are the benefits of this treatment?
  • How long will treatment?
  • What are the possible side effects?
  • How many unwanted effects may last treatment?
  • Can be long-term side effects from bisphosphonates?
  • Are there measures to reduce the negative effects arising therapy?
  • Who do I talk to if worried about side effects?

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