Metastatic Bone Disease Medication

Updated: Jan 11, 2018
  • Author: Howard A Chansky, MD; Chief Editor: Harris Gellman, MD  more...
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Medication

Medication Summary

Although patients are generally treated with surgery or radiation therapy, bisphosphonates are playing an increasingly important role in the treatment and prevention of metabolic bone disease. In the future, the modification of RANK ligands is expected to produce additional substances that can further arrest or retard bone destruction by metastatic disease. [1, 20]

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Calcium Metabolism Modifiers

Class Summary

Bisphosphonates can be given either orally or intravenously. The intravenous rout is preferred by many oncologists as it is given monthly as a short infusion and does not have the gastrointestinal adverse effects of the oral bisphosphonates. These agents are analogues of inorganic pyrophosphate and act by binding to hydroxyapatite in bone matrix, thereby inhibiting the dissolution of crystals. They prevent osteoclast attachment to the bone matrix and osteoclast recruitment and viability. The newer bisphosphonates are not completely free of the risk of causing a mineralization defect, but their safe therapeutic window is much wider.

Pamidronate (Aredia)

Pamidronate's main action is to inhibit the resorption of bone. The drug is adsorbed onto calcium pyrophosphate crystals and may block the dissolution of these crystals, also known as hydroxyapatite, which are an important mineral component of bone. There is also evidence that pamidronate directly inhibits osteoclasts. No food, indomethacin, or calcium should be ingested within 2 hours before and 2 hours after pamidronate administration. It is administered intravenously.

Zoledronate (Zometa)

Zoledronate inhibits bone resorption. It inhibits osteoclastic activity and induces osteoclastic apoptosis. The drug is adsorbed onto calcium pyrophosphate crystals and may block the dissolution of these crystals, also known as hydroxyapatite, which are an important mineral component of bone. No food, indomethacin, or calcium should be ingested within 2 hours before and 2 hours after zoledronate administration. It is administered intravenously.

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Monoclonal Antibodies

Class Summary

Denosumab binds to RANK ligand, a transmembrane or soluble protein essential for the formation, function, and survival of osteoclasts, the cells responsible for bone resorption.

Denosumab (Prolia, Xgeva)

Denosumab is a monoclonal antibody that specifically targets RANK ligand, an essential regulator of osteoclasts. Note that two brands exist; they are not interchangeable, and the doses are different. Xgeva is indicated for the prevention of skeleton-related events (SREs) in patients with multiple myeloma or in patients with cancer metastases from solid tumors. SREs include bone fractures from cancer and bone pain requiring radiation. Prolia is indicated in women with breast cancer who have aromatase inhibitor–induced bone loss. Prolia is also indicated for men with prostate cancer who have androgen deprivation–induced bone loss.

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