Bisphosphonates have an established role in treating tumor-induced
hypercalcemia and decreasing the incidence of skeletal-related events.
Recent data suggest that these agents may also prevent skeletal metastases.
This review explains how cancer metastasizes to bone and how
bisphosphonates may block this process, with a summary of clinical
trials supporting the use of bisphosphonates to treat and prevent bone
metastases. For skeletal metastases in patients with breast cancer,
multiple myeloma, or other solid tumors, bisphosphonates are important
adjuncts to systemic therapy. Despite promising results in metastatic
prostate cancer, additional trials are needed before bisphosphonates
become part of standard treatment in this setting. Ongoing trials are
evaluating the preventive role of the third-generation bisphosphonates
in breast cancer patients. Until the results of these trials are presented,
bisphosphonates should only become a component of adjuvant treatment
in the context of a clinical trial. Bone loss, a common consequence
of cancer treatment, should be treated with the usual measures indicated
for the management of osteoporosis, including bisphosphonates.