Optimal management of metastatic bone disease.
OBJECTIVE
Skeletal-related events (SREs) from bone metastases are a major cause of morbidity and significantly decrease patients' quality of life. Strategies for the optimal management of SREs with bisphosphonates are explored.


METHODS
Existing and novel therapies were identified and published guidelines were reviewed through PubMed key word searches.


RESULTS
Nitrogen-containing bisphosphonates effectively reduce the risk of SREs in patients with bone metastases from a variety of solid tumors and bone lesions from multiple myeloma. Review of placebo-controlled trials in breast cancer patients with bone metastases indicated that zoledronic acid produced the greatest SRE risk reduction of all bisphosphonates evaluated. Zoledronic acid has demonstrated significant long-term benefits for prevention of SREs and palliative effects for bone pain. Zoledronic acid also improves quality of life. Analysis of recent trials indicates that early zoledronic acid intervention provides greater benefit in asymptomatic patients.


CONCLUSIONS
Patients with malignant bone disease are at a continuous risk for SREs, and bisphosphonates reduce the incidence and delay the onset of SREs. Zoledronic acid has demonstrated the greatest SRE risk reduction of all bisphosphonates and significantly improves pain scores in patients with breast cancer. Zoledronic acid is the only bisphosphonate to show efficacy in prostate cancer, lung cancer, and other solid tumors.
Major
Pierre
P
McMaster University, Juravinski Cancer Centre, 699 Concession Street, Hamilton, Ontario, Canada L8V 5C2. Pierre.Major@hrcc.on.ca
D050071:Bone Density Conservation Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000556:secondary*; D004164:Diphosphonates / Q000494:pharmacology / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D006801:Humans; D007093:Imidazoles / Q000494:pharmacology / Q000627:therapeutic use*; D015994:Incidence; D009017:Morbidity; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010166:Palliative Care; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016896:Treatment Outcome; D000077211:Zoledronic Acid