Treatment
Table 3. Commonly Used Bone Modifying Agents for the
Prevention and Treatment of Osteoporosis in
Non-metastatic Cancer
Agent,
Route Dose and Schedule Key Adverse Effects
Oral Bisphosphonates
Alendronate Prevention: 5 mg daily or 35 mg once/wk
Treatment: 10 mg daily or 70 mg once/wk
Esophagitis
Dysphagia
Gastric ulcers
Rare (All Formulations):
Medication-related
osteonecrosis of the jaw
(MRONJ)
Bone pain
Atrial fibrillation
Esophageal cancer
Atypical fractures
Risedronate Prevention: 5 mg daily, or 35 mg once/wk
Treatment: 5 mg daily, 35 mg once/wk,
75 mg taken on two consecutive days each
month, or 150 mg once/month
Treatment in men: 35 mg once/wk
Ibandronate Prevention and treatment: 2.5 daily or
150 mg monthly
Intravenous (IV) Bisphosphonates
Zoledronic
acid
Prevention: 5 mg once every 2 years
Treatment: 5 mg yearly or 4 mg every
6 months
Myalgia
Arthralgia Fever
Headache
Rare (All Formulations):
MRONJ
Bone pain
Atrial fibrillation
Esophageal cancer
Atypical fractures
Hypocalcemia
Monoclonal antibodies
Denosumab,
(subcutaneous
injection)
Treatment: 60 mg every 6 months Common:
Arthralgias
Nasopharyngitis
Upper respiratory infection
Urinary tract infection
Back/extremity pain
Headache
Rare:
MRONJ
Serious infections
Sore throat
Rash
Asymptomatic hypocalcemia
