Yes, Xgeva can cause pain in the bones, muscles, and joints. Although the most common pain reported is back and joint pain, you should tell your doctor if you experience any new or unusual thigh, hip or groin pain; bone, joint, muscle, or jaw pain.

While bone pain is a common symptom of cancer that has spread to the bone, new types of pain may be related to Xgeva administration.

Pain in the bones, joints, or muscles may start soon after treatment or many months later, but usually in the first year of taking Xgeva. This pain may be severe and decrease your quality of life or it may be mild and barely noticeable.

Jaw pain, in particular, may be a sign of osteonecrosis of the jaw and must be reported to your doctor immediately. Osteonecrosis of the jaw has been reported more commonly in patients taking certain medications such as corticosteroids or angiogenesis inhibitors, who have been taking Xgeva for longer periods and in those who have poor oral hygiene, have previously had a tooth extracted, or who use a dental appliance. Symptoms of osteonecrosis of the jaw may include:

• Jaw pain
• Bone infection (osteomyelitis)
• Gingival ulceration or erosion
• Persistent pain in the mouth
• Slow healing of the mouth or jaw after dental surgery
• Tooth or periodontal infection
• Toothache.

Research has shown that for most patients, Xgeva is more effective than zoledronic acid at extending the bone pain-free interval. In those patients with advanced breast cancer with no to mild bone pain at baseline, the time it took for moderate-to-severe bone pain to develop was 3.9 months longer with Xgeva than zoledronic acid (9.7 months for Xgeva and 5.8 months for zoledronic acid). Overall across several different cancer types, Xgeva extended the pain-free interval by 1.8 months.

Other common side effects reported with Xgeva are diarrhea, headache, low phosphate levels, nausea, shortness of breath, and tiredness. Common serious adverse reactions include osteonecrosis of the jaw and osteomyelitis.