title: Reducing the burden of bone metastases: current concepts and treatment options.
abstract: BACKGROUND
  Bone metastases occur frequently in patients with solid tumours such as those of the prostate, breast and lung, and are associated with an increased risk of skeletal-related events (SREs). This article reviews the personal, social and economic burdens of bone metastases and SREs, and approaches to treatment.
  
  
  METHODS
  PubMed searches were conducted using a broad range of search terms. Articles identified were refined by author review of abstracts. Additional material was identified by searching recent relevant congress abstracts.
  
  
  RESULTS
  Bone metastases often decrease quality of life, but quantitative data on the extent of this effect are limited. Data from the USA demonstrate a significant financial burden associated with bone metastases; similar trends are now being uncovered in Europe as the number of assessments of health economics and healthcare resource utilisation in the region increases. The bisphosphonate zoledronic acid reduces the incidence of SREs compared with placebo. Recent phase 3 studies have shown that therapy with the RANK ligand inhibitor denosumab is superior to zoledronic acid for preventing or delaying SREs in patients with bone metastases from solid tumours. Denosumab also has a comparable safety profile to bisphosphonates, with reduced risk of renal toxicity and acute phase reactions. Data from Europe suggest that denosumab is cost-effective for the prevention of SREs compared with zoledronic acid. Additionally, several new experimental bone-targeted agents show promise.
  
  
  CONCLUSIONS
  Recent progress may help to reshape evidence-based guidelines to improve patient care and reduce the economic burden of bone metastases.
authors.affiliation: Medical Oncology/Haematology, Kantonsspital Graubünden, 7000, Chur, Switzerland. roger.vonmoos@ksgr.ch
authors.forename: Roger
authors.initials: R
authors.lastname: von Moos
authors.forename: Cora
authors.initials: C
authors.lastname: Sternberg
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Body
authors.forename: Carsten
authors.initials: C
authors.lastname: Bokemeyer
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000191:economics / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000191:economics / Q000556:secondary; D001943:Breast Neoplasms / Q000191:economics / Q000473:pathology / Q000628:therapy; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics / Q000473:pathology / Q000628:therapy; D008297:Male; D011471:Prostatic Neoplasms / Q000191:economics / Q000473:pathology / Q000628:therapy
chemical_list: D050071:Bone Density Conservation Agents