Bone integrity and bone metastases in breast cancer

Effect of bisphosphonates on pain and quality of life in patients with bone metastases

Bone is the most common organ for tumor metastasis, especially in patients with cancers of the breast or prostate. Bone metastases disrupt skeletal metabolism and result in considerable skeletal morbidity, including intractable, chronic bone pain, hypercalcemia of malignancy, pathologic fracture and spinal-cord compression. In addition to the chronic pain caused by bone metastases, skeletal-related events (SREs) such as pathologic fractures and spinal-cord compression can result in acute increases in pain. These effects can severely impair mobility and contribute to a general decrease in quality of life. Palliative options to treat bone metastases include radiotherapy, analgesics, surgery and bisphosphonates. These drugs bind to the surface of the bone and impair osteoclast-mediated bone resorption, and reduce the tumor-associated osteolysis that is initiated by the development of skeletal metastases. In addition to preventing SREs, bisphosphonates can palliate bone pain caused by a variety of solid tumors. This Review summarizes the clinical trial data of bisphosphonates for the prevention of SREs and the palliation of bone pain. Among these agents, nitrogen-containing bisphosphonates are recognized as the most effective, and zoledronic acid has demonstrated the broadest clinical utility.

Bisphosphonates for Breast Cancer: Questions Answered, Questions Remaining

Bone is an important organ that is essential to adult hematopoiesis, electrolyte balance, and locomotion. Individuals who have metastatic breast cancer involving the bone are at increased risk for skeletal complications and those who have a history of early-stage breast cancer may be at increased risk for fragility fractures. Maintaining bone integrity is critical to control the morbidity and mortality associated with fractures and other skeletal complications. The bisphosphonates have been shown to be efficacious in decreasing the risk for skeletal complications in cancer and in osteoporosis. The article reviews the use of bisphosphonates in patients who have breast cancer.