TABLE II.

Adverse events of bisphosphonates

Event	Route of administration	Patients affected (%)	Potential mechanisms29
Acute-phase reactions: fever and myalgia	Intravenous	15%–30%29	Systemic cytokine flare
Gastrointestinal symptoms	Oral	Dose dependent29	Local toxicity
Nephrotoxicity	Intravenous	Creatinine elevations: 2%–8%30	High drug concentrations in kidneys31
Osteonecrosis of the jaw	Intravenous (primarily)	Intravenous: 1.2%–2.4%31	Multiple risk factors
Hypocalcemia	Intravenous	4.7%31	Decreases in serum calcium and urinary calcium excretion