| HOME | HELP | CONTACT US | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Department of Oncology and Hematology, University Hospital, Modena, Italy
Correspondence: PierFranco Conte, M.D., Department of Oncology and Hematology, University Hospital, via del Pozzo 71, 41100 Modena, Italy. Telephone: 39-059-4224538/4224019 (secretary); Fax: 39-059-4224429; e-mail: conte.pierfranco{at}unimore.it
Patients with advanced cancers—particularly breast and prostate cancers—are at high risk for bone metastasis, leading to accelerated bone resorption and clinically significant skeletal morbidity. Bisphosphonates are effective inhibitors of bone resorption and reduce the risk of skeletal complications in patients with bone metastases. The standard routes of administration for bisphosphonates used in clinical practice are either oral or i.v. infusion. Oral administration of bisphosphonates is complicated by poor bioavailability (generally <5%) and poor gastrointestinal tolerability. First-generation bisphosphonates, such as clodronate (Bonefos®; Anthra Pharmaceuticals; Princeton, NJ), must be administered at high oral doses (1,600–3,200 mg/day) to achieve therapeutic effects, which leads to poor tolerability and compliance with oral dosing regimens. Infusion of bisphosphonates is associated with dose- and infusion-rate-dependent effects on renal function. In particular, high bisphosphonate doses (e.g., 1,500 mg clodronate) can cause severe renal toxicity unless infused slowly over many hours. In contrast, the newer, more potent bisphosphonates effectively inhibit bone resorption at micromolar concentrations, and the small doses required can be administered via relatively short i.v. infusions without adversely affecting renal function. Zoledronic acid (Zometa®; Novartis Pharmaceuticals Corp.; East Hanover, NJ) is a new generation bisphosphonate, and the recommended dose of 4 mg can be safely infused over 15 minutes. The 90-mg dose of pamidronate (Aredia®; Novartis Pharmaceuticals Corp.) and the 6-mg dose of ibandronate (Bondronat®; Hoffmann-La Roche Inc.; Nutley, NJ) require 1- to 4-hour infusions. Intravenous bisphosphonates require less frequent dosing (once a month) and are generally well tolerated with long-term use in patients with bone metastases. Zoledronic acid has demonstrated the broadest clinical activity in patients with bone metastases.
This article has been cited by other articles:
 |
|
 |
|
  T. Van den Wyngaert, T. Claeys, M. T. Huizing, J. B. Vermorken, and E. Fossion Initial experience with conservative treatment in cancer patients with osteonecrosis of the jaw (ONJ) and predictors of outcome Ann. Onc., October 26, 2008; (2008) mdn630v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Mariotti Bisphosphonates and Osteonecrosis of the Jaws J Dent Educ., August 1, 2008; 72(8): 919 - 929. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Simonen, Y. Ibig-Rehm, G. Hofmann, J. Zimmermann, G. Albrecht, M. Magnier, V. Heidinger, and D. Gabriel High-Content Assay to Study Protein Prenylation J Biomol Screen, July 1, 2008; 13(6): 456 - 467. [Abstract] [PDF]
|
|
|
|
 |
|
 A. M. Brufsky Cancer Treatment-Induced Bone Loss: Pathophysiology and Clinical Perspectives Oncologist, February 1, 2008; 13(2): 187 - 195. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Olson and C. Van Poznak Significance and impact of bisphosphonate-induced acute phase responses Journal of Oncology Pharmacy Practice, December 1, 2007; 13(4): 223 - 229. [Abstract] [PDF]
|
|
|
|
|
|
D Aguiar Bujanda, U Bohn Sarmiento, M. Cabrera Suarez, and J Aguiar Morales Assessment of renal toxicity and osteonecrosis of the jaws in patients receiving zoledronic acid for bone metastasis Ann. Onc., March 1, 2007; 18(3): 556 - 560. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Guise Bone Loss and Fracture Risk Associated with Cancer Therapy Oncologist, November 1, 2006; 11(10): 1121 - 1131. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Van den Wyngaert, M. T. Huizing, and J. B. Vermorken Bisphosphonates and osteonecrosis of the jaw: cause and effect or a post hoc fallacy? Ann. Onc., August 1, 2006; 17(8): 1197 - 1204. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Botteman, V. Barghout, J. Stephens, J. Hay, J. Brandman, and M. Aapro Cost effectiveness of bisphosphonates in the management of breast cancer patients with bone metastases Ann. Onc., July 1, 2006; 17(7): 1072 - 1082. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Carteni, R. Bordonaro, F. Giotta, V. Lorusso, S. Scalone, V. Vinaccia, R. Rondena, and D. Amadori Efficacy and Safety of Zoledronic Acid in Patients with Breast Cancer Metastatic to Bone: A Multicenter Clinical Trial Oncologist, July 1, 2006; 11(7): 841 - 848. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Tanvetyanon and P. J. Stiff Management of the adverse effects associated with intravenous bisphosphonates Ann. Onc., June 1, 2006; 17(6): 897 - 907. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. B. Michaud and S. Goodin Cancer-treatment-induced bone loss, part 2 Am. J. Health Syst. Pharm., March 15, 2006; 63(6): 534 - 546. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Bell Efficacy of Ibandronate in Metastatic Bone Disease: Review of Clinical Data Oncologist, October 1, 2005; 10(suppl_1): 8 - 13. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. A. Chabner Late Toxicities of Drugs: Bisphosphonates Oncologist, May 1, 2005; 10(5): 301 - 303. [Full Text] [PDF]
|
|
|
|
|
|
G. Jackson Safety and Compliance of Intravenous and Oral Dosing Regimens Oncologist, May 1, 2005; 10(5): 313 - 314. [Full Text] [PDF]
|
|
|
|
|
|
J.-J. Body Bisphosphonate Safety and Tolerability Oncologist, May 1, 2005; 10(5): 317 - 317. [Full Text] [PDF]
|
|
|
|
|
|
P. Conte Optimizing Bisphosphonate Therapy in Oncology Oncologist, September 1, 2004; 9(suppl_4): 1 - 2. [Full Text] [PDF]
|
|
|
|
|
|
R. E. Coleman Bisphosphonates: Clinical Experience Oncologist, September 1, 2004; 9(suppl_4): 14 - 27. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | CONTACT US | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| THE ONCOLOGIST | STEM CELLS | CME | ALPHAMED PRESS JOURNALS |
