Table 17.

Adverse Events of Bisphosphonate Treatment

Risk‐benefit balance

Serious adverse events with bisphosphonates are rare. In PDB, oral bisphosphonates have a similar adverse event profile as placebo but that a transient flu‐like illness occurs commonly with zoledronic acid. Usually this is of mild to moderate severity but can be severe in some patients.

Quality of evidence

Very low

Patient values and preferences

Adverse events are of concern to patients and a proportion of individuals may decline treatment because of the risk of adverse events.

Costs and use of resources

Bisphosphonates are inexpensive, but intravenous therapy involves additional support costs that may need to be considered.

Recommendation

We recommend that patients undergoing treatment with bisphosphonates for PDB are informed about their favorable adverse event profile. We also recommend that patients are advised that a transient flu‐like illness occurs commonly with intravenous zoledronic acid.