Primary Indications in Patients with Cancer
To protect bone from new metastatic lesions
To treat hypercalcemia of malignancy
To prevent treatment-related bone demineralization, osteolysis, and pathologic fractures
To treat osteolytic lesions, decrease the incidence of pathologic fractures, prevent skeletal deformities, and prevent and decrease the severity of pain
Intravenous Versus Oral Bisphosphonates
Much more effective than oral agents at reversing hypercalcemia and relieving bone pain, particularly in patients with breast cancer and multiple myeloma
Can overcome disadvantages associated with oral agents, including poor absorption from the GI tract (<3% oral bioavailability); have a lower incidence of adverse GI events
Require clinic/hospital administration
Absorption can be impaired by food and beverages other than water
Associated with greater incidence of upper GI toxicity than with intravenous administration, including dysphagia; esophagitis; and esophageal, gastric, or duodenal erosion; ulceration; and perforation
Body JJ et al. J Clin Oncol 1998;16:3890–3899
Riccardi A et al. Tumori 2003;89:223–236
|Bisphosphonate ||Median Time to Normocalcemia ||Duration of Normocalcemia ||% Achieving Normocalcemia |
|Zoledronic acid1 ||4 days ||32 days ||87 |
|Pamidronate2,3 ||4 days ||28 days ||70-100 |
|Clodronate3 ||3 days ||14 days ||80 |
|Alendronate4 ||4 days ||15 days ||74 |
|Ibandronate5 ||4 days ||14 days ||76.5 |
|Etidronate6 ||4 days ||29 days ||63 |
et al. Br J Cancer 1995;72:1289–1293
et al. Arch Int Med 1991;151:471–476
The American Society of Bone and Mineral Research Task Force has defined osteonecrosis of the jaw (ONJ) as the presence of exposed bone in the maxillofacial region that does not heal within 8 weeks after identification by a healthcare professional1
Potential risk factors for developing ONJ in patients with cancer2:
Poor oral hygiene and periodontal disease3
History of dental procedures for extractions or denture use (that may cause soft tissue injury)
Prolonged exposure to high doses of intravenous bisphosphonates
Intravenous bisphosphonate use poses greater risk than oral bisphosphonates
Zoledronic acid seems to cause more ONJ compared to pamidronate4
ONJ developed in 7% to 10% of patients with myeloma and 4% of patients with breast cancer
Among patients on oral bisphosphonates (eg, alendronate), there is a very low risk (estimated at 0.7 cases of per 100,000 person-years exposure) of developing bone osteonecrosis5
Radiation-induced damage with head and neck cancer or oral cancer3
Concomitant therapy with corticosteroids; chemotherapy3
Clinical presentation ...
Log In to View More
If your institution is currently a subscriber
of the HemOnc Collection please sign in below.
If your institution is not a subscriber
please click here
to learn more.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.