Bisphosphonate infusion guideline

Indications for IV bisphosphonates:


Tests prior to infusion

How to arrange admission

Referral letter to Endocrine SpR in charge of admission for infusion of 5mg Zoledronate



[1] Green et al., 2010 suggested there may be a small increase in the risk of oesophageal cancer in patients who had taken oral bisphosphonates for more than five years compared with a group who had not take oral bisphosphonates. A subsequent study of patients in the UK General Practice Research Database cohort of 40,000 patients treated with oral bisphosphonates followed over 4½ years found the use of oral bisphosphonates was not significantly associated with incident esophageal or gastric cancer, Cardwell et al., 2010.

 [2] Osteonecrosis of the jaw has been reported, especially in patients also receiving steroids, radiotherapy, and chemotherapy who have had invasive dental surgery.  The onset can occur from months to years after the start of bisphosphonate therapy (Khosla et al. 2007). A review of clinical trials by Grbic et al found that of 5,903 patients with osteopaenia or osteoporosis who received zolendronate in five clinical trials, ONJ incidence was less than one in 14,200 patient treatment-years.


Cardwell et al. JAMA. 2010 Aug 11;304(6):657-63. Exposure to oral bisphosphonates and risk of esophageal cancer.

Grbic et al., J Am Dent Assoc. 2010 Nov;141(11):1365-70. The incidence of osteonecrosis of the jaw in patients receiving 5 milligrams of zoledronic acid: data from the health outcomes and reduced incidence with zoledronic acid once yearly clinical trials program.

Green J, Czanner G, Reeves G, Watson J, Wise L, Beral V. Oral bisphosphonates and risk of cancer of oesophagus, stomach, and colorectum: case-control analysis within a UK primary care cohort.  BMJ. 2010 Sep 1;341:c4444. doi: 10.1136/bmj.c4444.

Khosla S et al 2007 Bisphosphonate-Associated Osteonecrosis of the Jaw: Report of a Task

Force of the American Society for Bone and Mineral Research J Bone Miner Res 2007;22:1479–1491