Many patients with advanced
cancer experience decreased bone strength due to metastatic foci, underlying
osteoporosis and/or
cancer treatment induced bone loss. The clinical consequences of metastatic disease involving the skeleton are widespread. This review focuses on the efficacy, pharmacology, and safety when using intravenous biphosphonate such a
zoledronic acid for
cancer bone
metastases.
Zoledronic acid is the gold standard for the medical management of metastatic
bone disease. The indications for treatment include prevention of skeletal relevant events (SRE), osteoporotic complications, and palliation of bone
pain, among others.
Zoledronic acid is the only
bisphosphonate effective in decreasing SREs associated with bone
metastases from advanced
renal cell carcinoma and
prostate cancer. Regarding
prostate cancer,
zoledronic acid effectively prevents both bone loss in patients with locally advanced disease receiving
androgen deprivation
therapy and SREs in men with
hormone-refractory or
hormone-sensitive metastatic disease.
Zoledronic acid has an acceptable safety profile and tolerability, and has been effective at significantly decreasing the incidence, delaying the onset, and reducing the overall risk of experiencing an SRE compared to placebo. It is the only
bisphosphonate currently approved for the prevention and treatment of skeletal complications in patients with bone
metastases due to all solid
tumors.