The use of bisphosphonates in cancer patients

Abstract

Skeletal-related events resulting from bone metastases or osteoporosis can significantly contribute to morbidity and mortality in cancer patients. Expert opinion on the effectiveness of bisphosphonates in this setting is evolving. Here we review current evidence on the risks and benefits of bisphosphonate therapy for a wide variety of cancers, as well as clinical management of its adverse effects. A MEDLINE search of English-language literature (1966 through May 2006) was conducted using the terms bisphosphonate, cancer, multiple myeloma, malignancy, and randomized controlled clinical studies. Studies were selected based on clinical pertinence, with an emphasis on phase III clinical trials. We reviewed bibliographies for other relevant articles. Accumulating evidence reveals that bisphosphonate therapy has a significant effect in preventing skeletal complications in multiple myeloma, breast cancers, and prostate cancer, and in reducing skeletal complications in other metastatic bone malignancies. Emerging data indicate that bisphosphonates are useful for preventing bone loss resulting from cancer or its therapy. The efficacy of bisphosphonates for early-stage breast cancers remains controversial. Significant risks of bisphosphonate therapy include nephrotoxicity, electrolyte abnormalities, and osteonecrosis of the jaw. Bisphosphonate therapy has a clear role in the management of skeletal metastases associated with a variety of cancers. However, significant side effects require ongoing monitoring and treatment.

Osteonecrosis of the jaw induced by oral administration of bisphosphonates in Asian population: five cases

“…Bisphosphonates are widely used to treat malignant bone diseases such as multiple myeloma and bone metastases from breast or prostate cancer [1][2][3]. They are also commonly prescribed to patients who have a resorptive bone disease such as osteoporosis or Paget's disease [4,5].…”

Bisphosphonate-related Osteonecrosis of Jaw (BRONJ) in Japanese Population: A Case Series of 13 Patients at Our Clinic

“…The use of oral BPs has been approved in the treatment of metabolic diseases such as osteoporosis and Paget's disease 3,4) . Intravenous BPs are used in the treatment of bone metastases from malignant diseases such as breast or prostate cancer or multiple myeloma 2,13,18) . Marx was the first to report osteonecrosis of the jaw due to administration of BP in 2003 15) , and many studies since then have confirmed BPS-related osteonecrosis of the jaw (BRONJ) as an adverse side effect of BP therapy.…”

Nephrotic syndrome and renal failure in a patient with metastatic breast cancer

“…The administration of bisphosphonates plays a pivotal role in delaying the appearance of clinical skeletal complications among patients with breast carcinoma on systemic chemotherapy [6]. Although the prolonged intravenous administration of bisphosphonates in patients with malignancy is well-tolerated [7], numerous studies have demonstrated various pathophysiological effects on the kidney, such as the collapsing form of FSGS, minimal change disease, and acute tubular necrosis, over the past decade [2].…”