Bisphosphonates are drugs that prevent bone from breaking down or becoming reabsorbed. There are two FDA approved drugs in this class, zoledronic Acid (Zometa) and denosumab (Xgeva).

Zoledronic acid (Zometa) is the most commonly used bisphosphonate in men with advanced prostate cancer. Zometa not only reduces the risk of developing bone complications, it also controls existing bone metastases. Zometa is prescribed for men with castrate resistant prostate cancer after ADT fails.  This should not be confused with taking oral bisphosphonates to maintain bone mineral density (BMD).

Stay well hydrated while getting your infusion.

Zometa is administered by infusion (IV). Be sure that you are well hydrated by drinking a lot of water prior to the infusion (and during it).  Make sure that the infusion staff member monitors your electrolytes during the treatment course. A small number of men experience incapacitating bone, joint and/or muscle pain. If you do, discontinue the bisphosphonate treatment. In order to minimize potential side effects, ask your doctor to time your initial infusion rate to not less than one hour, and then not less than 30 minutes for each subsequent infusion.

Denosumab (Xgeva), approved by the FDA in November 2010, is the newest of the bisphosphonates, and is a human monoclonal antibody for the treatment of osteoporosis, treatment-induced bone loss (i.e. by ADT), and bone metastases in men with castrate resistant non-metastatic prostate cancer.

Compared to Zometa, Xgeva has been shown to delay the onset of bone problems, including bone metastases. It also has been shown to reduce pain and improve the a man’s quality of life ( ). It is delivered monthly via injection. (Citation: XGEVA Delays The Onset Of Bone Metastases In Men With NonMetastatic Castrate Resistant Prostate Cancer