This Article Full Text Full Text (PDF) eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Coleman, R. E. Search for Related Content PubMed PubMed Citation Articles by Coleman, R. E.

Management of Bone Metastases

Yorkshire Cancer Research Department of Clinical Oncology, Cancer Research Center, Weston Park Hospital, Sheffield, England

Correspondence: Robert E. Coleman, M.D., F.R.C.P. (Lond. & Edin.), Professor of Medical Oncology, Yorkshire Cancer Research Department of Clinical Oncology, Cancer Research Centre, Weston Park Hospital, Whitham Road, Sheffield, S10 2SJ England. Telephone: 44-0-114-226-5213; Fax: 44-0-114-226-5678; e-mail: r.e.coleman{at}sheffield.ac.uk.

Metastatic bone disease develops as a result of the many interactions between tumor cells and bone cells. This leads to disruption of normal bone metabolism, with the increased osteoclast activity seen in most, if not all, tumor types providing a rational target for treatment. The clinical course of metastatic bone disease in multiple myeloma, breast and prostate cancers is relatively long, with patients experiencing sequential skeletal complications over a period of several years. These include bone pain, fractures, hypercalcemia, and spinal cord compression, all of which may profoundly impair a patient's quality of life.

External beam radiotherapy and systemic endocrine and cytotoxic treatments are the mainstay of treatment in advanced cancers. However, it is now clear that the bisphosphonates provide an additional treatment strategy, which reduces both the symptoms and complications of bone involvement. Additionally, new specific molecules such as osteoprotogerin have been developed that are based on our improved understanding of the cellular signaling mechanisms involved in cancer-induced bone disease. These potent molecules are now entering clinical trials.

Ongoing research is aimed at trying to define the optimum route, dose, schedule and type of bisphosphonate in metastatic bone disease and its use in the prevention and treatment of osteoporosis in cancer patients. In vitro suggestions of direct anticancer activity and some promising clinical data in early breast cancer have resulted in considerable interest in the possible adjuvant use of bisphosphonates to inhibit the development of bone metastases.

Key Words. Metastatic bone disease • Hypercalcemia • Bisphosphonates • Osteoprotogerin

This article has been cited by other articles:

				Y. Du, I. Cullum, T. M. Illidge, and P. J. Ell Fusion of Metabolic Function and Morphology: Sequential [18F]Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography Studies Yield New Insights Into the Natural History of Bone Metastases in Breast Cancer J. Clin. Oncol., August 10, 2007; 25(23): 3440 - 3447. [Abstract] [Full Text] [PDF]

				J. M. Lee, S. H. Choi, H. S. Park, M. W. Lee, C. J. Han, J.-i. Choi, J.-Y. Choi, S. H. Hong, J. K. Han, and B. I. Choi Radiofrequency Thermal Ablation in Canine Femur: Evaluation of Coagulation Necrosis Reproducibility and MRI-Histopathologic Correlation Am. J. Roentgenol., September 1, 2005; 185(3): 661 - 667. [Abstract] [Full Text] [PDF]

				J. T. Price, J. M.W. Quinn, N. A. Sims, J. Vieusseux, K. Waldeck, S. E. Docherty, D. Myers, A. Nakamura, M. C. Waltham, M. T. Gillespie, et al. The Heat Shock Protein 90 Inhibitor, 17-Allylamino-17-demethoxygeldanamycin, Enhances Osteoclast Formation and Potentiates Bone Metastasis of a Human Breast Cancer Cell Line Cancer Res., June 1, 2005; 65(11): 4929 - 4938. [Abstract] [Full Text] [PDF]

				T. Hamaoka, J. E. Madewell, D. A. Podoloff, G. N. Hortobagyi, and N. T. Ueno Bone Imaging in Metastatic Breast Cancer J. Clin. Oncol., July 15, 2004; 22(14): 2942 - 2953. [Abstract] [Full Text] [PDF]

				E. Alvarez, M. Westmore, R. J. S. Galvin, C. L. Clapp, E. L. Considine, S. J. Smith, K. Keyes, P. W. Iversen, D. M. Delafuente, S. Sulaimon, et al. Properties of Bisphosphonates in the 13762 Rat Mammary Carcinoma Model of Tumor-Induced Bone Resorption Clin. Cancer Res., November 15, 2003; 9(15): 5705 - 5713. [Abstract] [Full Text] [PDF]