Bone-strengthening drugs for cancer are now available. They can help treat cancer that has spread to the bones (bone metastasis), which is quite common. In many cases, they can be used as soon as bone metastases are diagnosed.
These drugs not only reduce the risk of fractures (a common complication) but may, in some cases, improve survival. That’s because they also have anti-cancer properties.
This article looks at the new drugs for bone metastases, how they work, and other possible treatments.
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Prescriptions
Two primary classes of drugs are used to treat bone metastases. These include:
These bone-modifying agents can help people with cancer in several ways:
Bone-modifying agents are recommended for anyone with breast cancer that’s spread to the bone and are frequently used with other solid tumors (such as lung cancer).Other treatments (such as radiation therapy) are usually needed, as are medications to control pain.
Bisphosphonates
Bisphosphonates suppress the breakdown of bone, which improves bone density. They were first used to treat osteoporosis and later noted to help with bone metastases.
Bisphosphonates most commonly used for bone metastases are given intravenously (into a vein). They include:
Use in Breast Cancer
Side Effects
Zometa and Aredia can causeside effects, including:
Bisphosphonates may not be recommended for people with kidney disease.
Monoclonal Antibody
Denosumab is a monoclonal antibody (man-made antibody) that can reduce complications of bone metastases, including fractures. It’s sold under two brand names, Xgeva and Prolia.
A 2016 review of studies looked at three clinical trials of denosumab as a treatment for:
With breast cancer and prostate cancer, denosumab was better than Zometa in reducing the risk of fractures related to bone metastases. With multiple myeloma and other solid tumors, denosumab was about as effective as Zometa.
Denosumab was also found to reduce the risk of treatment-related osteoporosis in breast cancer and prostate cancer.
Long-term use of denosumab is more likely than bisphosphonates to cause a low calcium level. For this reason, experts often recommend taking calcium andvitamin D supplementsduring treatment.
Some denosumab side effects are delayed while others are likely to happen soon after taking it. The short-term side effects include:
Unlike bisphosphonates, denosumab is safe for people with impaired kidney function.
Complications
A rare but serious complication of bisphosphonates and denosumab is osteonecrosis of the jaw, a condition that makes part of the jaw bone break down. People assigned female at birth and treated with Zometa for early-stage breast cancer appear to have about a 2% risk of this.
While any bisphosphonates can cause osteonecrosis, 94% of cases are in people who’ve had it in high-dose IV form, not in doses given for osteoporosis.
Osteonecrosis of the jaw is more likely if you:
Scheduling dental exams every three months and using preventive antibiotics for dental procedures may reduce the risk. Treatment options include a combination of surgery, rinses, antibiotics, and hyperbaric oxygen treatments.
Before Beginning TreatmentBefore you start treatment with either denosumab or bisphosphonates, you should have a thorough dental exam looking for evidence of gum disease. Any dental work you need should be done before starting these drugs.
Before Beginning Treatment
Before you start treatment with either denosumab or bisphosphonates, you should have a thorough dental exam looking for evidence of gum disease. Any dental work you need should be done before starting these drugs.
Guidelines for Bone-Modifying Agents With Bone Metastases
For breast cancer, prostate cancer, and other solid tumors with bone metastases, the American Society of Clinical Oncology recommends these drugs and dosage schedules.
Surgeries and Specialist-Driven Procedures
Many other options are available for treating bone metastases. These include some general treatments for metastatic cancer, including:
Treatments that specifically address bone metastases are:
Summary
Bone metastases can reduce your quality of life and lower your chance of survival. Bone-modifying agents are a relatively new approach and are now recommended early on after a diagnosis of bone metastases for many cancers.
The bisphosphonates Aredia and Zometa and the monoclonal antibody denosumab can reduce the risk of fractures. Both classes of medications carry a small risk of osteonecrosis of the jaw. A dental exam is recommended before starting these drugs.
In addition to reducing fracture risk, these medications can help correct bone loss due to hormonal therapies used for breast and prostate cancers. Both bisphosphonates and denosumab appear to have significant anti-cancer activity. Zometa is also recommended as an add-on treatment for early-stage breast cancer to reduce the chance of bone metastases.
A Word From Verywell
The addition of new drugs to the cancer-fighting arsenal is good news. They give you and your healthcare team more options and better odds of defeating these diseases.
Educating yourself about your cancer and the possible treatments for it can help you be an active participant in your care.
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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