Bisphosphonates: Expanded Roles in the Treatment of Patients With Cancer

Abstract

Bisphosphonates are important inhibitors of osteoclastic bone resorption seen in patients with bone metastases associated with malignancy. Bisphosphonates are used in the treatment of patients with bone metastases and have been shown to reduce skeletal-related events and symptoms, contributing to improved patient outcomes and quality of life. These agents first were approved in the treatment of patients with osteoporosis and have been used for the past two decades in this role. Because bisphosphonates inhibit osteoclast-mediated bone resorption, the bone remodeling cycle slows down and an increase in bone mineral density occurs. These agents are useful in treatment for both hypercalcemia and pain, although they have not definitively shown improvement in survival time. Considerable interest exists in the use of bisphosphonates for prevention of bone metastases and their potential antitumor activity. These drugs are well tolerated and have minimal side effects, but they are not inexpensive. This article discusses the role of bisphosphonates in patients with cancer and future directions for further research.

Cancer Treatment-Induced Bone Loss in Patients With Breast or Prostate Cancer

“…Preventing falls that could lead to injury or fracture is essential (Brown & Josse, 2002;Follin, 2003). If necessary, patients should use assistive devices, such as a cane or walker, to maintain balance and protect against falls (Viale & Sanchez Yamamoto, 2003).…”

“…Additionally, gastrointestinal adverse effects of oral bisphosphonates limit the administration of optimal doses and may be accentuated with the use of nonsteroidal anti-infl ammatory drugs (Graham & Malaty, 2001;Reid et al, 2002). Therefore, the use of IV bisphosphonates for the prevention or treatment of CTIBL may be more appealing because these drugs can be administered less frequently without regard to timing of food intake and are more potent than oral bisphosphonates (Berruti, Tucci, et al;Viale & Sanchez Yamamoto, 2003).…”

Exposed Bone in Oral Cavities

“…The bisphosphonate drugs work by inhibiting the activity of osteoclast cells that resorb or break down bone and may help to reduce tumor burden. Bisphosphonates have been shown to inhibit tumor cells, possibly by inducing apoptosis (Melo & Obeid, 2005;Viale & Yamamoto). The agents also have antiangiogenic properties (Melo & Obeid).…”

“…Normal bone remodeling is a balanced process involving osteoclasts, which are responsible for bone resorption, and osteoblasts, which are responsible for bone growth; however, in patients with bone metastases, this process becomes unbalanced with increased osteoclast and/or osteoblast activity, resulting in bony complications (Viale & Yamamoto, 2003). The bisphosphonate drugs work by inhibiting the activity of osteoclast cells that resorb or break down bone and may help to reduce tumor burden.…”

Clinical Update: A Nonhealing Fractured Mandible

“…In bone disorders with increased osteoclastic activity, such as osteoporosis, multiple myeloma, hypercalcemia of malignancy, and bone metastases, bisphosphonates have been found to be benefi cial in preventing skeletal fractures and reducing bone pain and bony complications (Carter, Goss, & Doecke, 2005;Viale & Sanchez Yamamoto, 2003). Bisphosphonates obstruct bone resorption through selective concentration at the border of the active osteoclast and the bone resorption surface, resulting in the inhibition of osteoclastic activity.…”