Certain primary tumours including breast and
prostate cancers have a particular propensity for
metastasis to bone. Metastatic
bone disease can have significant impact on morbidity and mortality of
cancer patients. Skeletal-morbidity (
spinal cord compression, hypercalcaemia, fracture, need for
radiotherapy and surgery to bone) can be effectively reduced by
bisphosphonates, a class of anti-resorptive drugs. They are also effective in relieving
pain from bone
metastases, and may improve survival in patients with accelerated
bone resorption. Additionally, there is an exciting body of evidence that suggest these drugs may have anti-
tumor effects that may be exploited to prevent or delay the development of bone
metastases. Reported effects include inhibition of
cancer cell migration, adhesion and invasion as well as anti-angiogenic and immunomodulating effects. The pre-clinical evidence is compelling, and some recently reported randomised clinical studies go part way to support their use in clinical practice at earlier stages of the disease to prevent bone
metastases. However, further results are awaited before routine clinical use in the adjuvant setting can be recommended.