Bisphosphonates in prevention and control of skeletal-related events in cancer patients with bone metastases

Abstract

The current use of bisphosphonates in metastatic bone disease includes their administration to prevent skeletal-related events, reduce bone pain and improve quality of life. The results of several randomized trials have established efficacy of bisphosphonates (clodronate and pamidronate) against bone complications in patients with breast cancer and multiple myeloma. Recently, trials of zoledronic acid have confirmed its value in prostate cancer and some other solid tumours (eg. non-small-cell lug cancer). Ibandronate is a new bisphosphonate of confirmed efficacy in patients with breast cancer and bone metastases. Bisphosphonates have also some effect on metastatic bone pain. The safety profiles of bisphosphonates are important - although bisphosphonates are well tolerated in general, they are sometimes associated with adverse events (eg., hypocalcemia, renal toxicity, and osteonecrosis of the jaw). The evidence from adjuvant clinical trials of bisphosphonates is conflicting and more prospective studies are needed to further investigate this issue. This review relates to the efficacy and safety of bisphosphonates in various clinical situations.