title: Ibandronate: The loading dose concept in the treatment of metastatic bone pain.
abstract: OBJECTIVE
  Severe bone pain is experienced by 60-80% of patients with metastatic bone disease, and has a profound impact on quality of life. Therefore, effective pain relief is an important goal in managing metastatic bone disease. Orthopedic surgeons are often challenged with patients presenting with newly diagnosed bone metastases and severe and disabling bone pain. It is important to provide fast and sufficient analgesia. Clinical trials have demonstrated that bisphosphonates reduce effectively and sustained bone pain by approved standard dosage over time. Open label prospective trials have shown that short time high dose i.v. Ibandronate is effective in rapid pain relief in different primary tumors.
  
  
  METHODS
  In 33 patients with metastatic bone pain from newly diagnosed skeletal metastases we utilized the loading-dose concept for intravenous ibandronate (6 mg infused over 1 h on 3 consecutive days).
  
  
  RESULTS
  In 33 patients loading-dose ibandronate therapy significantly reduced bone pain within the first 5-7 days (VAS day 0: 6-8 vs. day 7: 3-4). Only 3 patients showed no response concerning a distinct pain reduction within the first days of therapy. There was no increase in pain medication.
  
  
  CONCLUSIONS
  This clinical observational study in selected patients with severe metastatic bone pain undergoing an intensive high dosed ibandronate-therapy for a short period demonstrated that loading-dose ibandronate (6 mg i.v., 3 consecutive days) resulted in a reduction of pain within days.
authors.affiliation: Department of Orthopaedic Surgery, Pius Hospital, Carl von Ossietzky University, Georgstr. 12, 26121 Oldenburg, Germany.
authors.forename: Gerrit Steffen
authors.initials: GS
authors.lastname: Maier
authors.affiliation: Department of Trauma Surgery, Klinikum Hanau, Leimenstr. 20, 63450 Hanau, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Eberhardt
authors.affiliation: Department of Orthopaedic Surgery, Themistocles Gluck Hospital, Rosenstr. 2, 40882 Ratingen, Germany.
authors.forename: Andreas Alois
authors.initials: AA
authors.lastname: Kurth
keywords: Bisphosphonate; Bone metastases; Ibandronate; Pain relief