In some people, bisphosphonates and denosumab can cause bone, joint or muscle pain.  Any of these side effects should be reported to a health care provider right away.  Some people who take bisphosphonates need to increase their intake of vitamin D and calcium.  If you develop muscle twitching or increased anxiety, ask your provider if you should take supplements to keep your vitamin D and calcium levels up.  In rare cases, with either type of drug, a disorder called osteonecrosis of the jaw may occur.  Before you start treatment with bisphosphonates, it’s a good idea to have a dental exam.  Talk with your oncologist before getting any dental procedure while you are being treated with bisphosphonates or denosumab.

Source: Susan G. Komen   2019