title: Use of intravenous bisphosphonates in patients with breast, lung, or prostate cancer and metastases to bone: a 15-year study in two large US health systems.
abstract: OBJECTIVE
  The purpose of this paper is to document the use of intravenous (IV) bisphosphonates for prevention of skeletal-related events (SREs) in patients with bone metastases (BM) due to breast cancer (BC), lung cancer (LC), or prostate cancer (PC).
  
  
  METHODS
  Using data from two large US health systems, we identified all patients aged ≥ 18 years with primary BC, LC, or PC and newly diagnosed BM between 1/1/1995 and 12/31/2009. Starting with the diagnosis of BM, we reviewed medical and administrative records for evidence of receipt of IV bisphosphonates (zoledronic acid or pamidronate) and occurrence of SREs. Initiation of IV bisphosphonates prior to occurrence of an SRE was designated "primary prophylaxis"; use following an SRE was designated "secondary prophylaxis".
  
  
  RESULTS
  We identified a total of 1,193 patients with newly diagnosed BM, including 400 with BC, 332 with LC, and 461 with PC. Use of IV bisphosphonates was substantially higher in BC (55.8 % of all patients) than in LC (14.8 %) or PC (20.2 %). Use of IV bisphosphonates was fairly evenly split between primary and secondary prophylaxis in BC (26.3 vs. 29.5 %, respectively) and PC (10.6 vs 9.5 %); in LC, however, primary prophylaxis was much less common than secondary prophylaxis (4.8 vs 9.9 %).
  
  
  CONCLUSIONS
  Almost one half of all patients with BM due to BC, and substantially more with LC and PC, do not receive IV bisphosphonates. Among patients receiving such therapy, treatment often is not initiated until after the occurrence of an SRE. Our study suggests that IV bisphosphonates may be substantially underutilized in patients with BM due to these common cancers.
authors.affiliation: Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA, 02445, USA, goster@pai2.com.
authors.forename: Gerry
authors.initials: G
authors.lastname: Oster
authors.forename: Lois
authors.initials: L
authors.lastname: Lamerato
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Glass
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Richert-Boe
authors.forename: Andrea
authors.initials: A
authors.lastname: Lopez
authors.forename: Karen
authors.initials: K
authors.lastname: Chung
authors.forename: Akshara
authors.initials: A
authors.lastname: Richhariya
authors.forename: Tracy
authors.initials: T
authors.lastname: Dodge
authors.forename: Greg G
authors.initials: GG
authors.lastname: Wolff
authors.forename: Arun
authors.initials: A
authors.lastname: Balakumaran
authors.forename: John
authors.initials: J
authors.lastname: Edelsberg
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology; D004164:Diphosphonates / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage*; D008175:Lung Neoplasms / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008875:Middle Aged; D000077268:Pamidronate; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000473:pathology; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D000077268:Pamidronate