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What bisphosphonates are

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This page tells you about bisphosphonate treatment for cancer. There is information below about

 

A quick guide to what's on this page

What bisphosphonates are

Bisphosphonates are drugs that slow down or prevent bone damage. Some cancers can cause bone pain and weakness. This usually occurs when cancer has spread to the bone from another part of the body (called secondary bone cancer).

You may have bisphosphonates to prevent or control bone thinning, lower the risk of bones breaking, lower the level of calcium in the blood, or to reduce pain.

How bisphosphonates work

Some types of cancer can spread into the bone and damage it as they grow. Cancer cells that have spread to the bone release proteins that change the balance between bone breakdown and growth. This makes the bones weaker and releases calcium into the blood.  

Symptoms of a high calcium level include

  • Feeling thirsty
  • Constipation
  • Feeling sick
  • Feeling drowsy

Bisphosphonates help to stop bone breakdown. 

Bisphosphonates for cancer

There are different types of bisphosphonates and they work slightly differently. Those used for cancer include

  • Disodium pamidronate (Aredia)
  • Ibandronic acid (Bondronat)
  • Sodium clodronate (Bonefos, Clasteon, Loron)
  • Zoledronic acid (Zoledronate, Zometa). 

You have some of these drugs as a drip into your bloodstream and others you take as tablets or capsules.

 

CR PDF Icon You can view and print the quick guides for all the pages in the Bisphosphonates section.

 

 

What bisphosphonates are

Bisphosphonates are drugs used to slow down or prevent bone damage. They also lower calcium levels. You may hear them called bone hardening or bone strengthening treatment. Some cancers can cause bone pain and weakness. These are most often cancers that have started in another part of the body and have spread to the bone (secondary bone cancer). Some types of cancer treatment, such as chemotherapy and hormone therapies, can also weaken the bones.

The most common types of cancer that can affect your bones are

Your doctors may prescribe bisphosphonates to

  • Prevent or control bone thinning (osteoporosis)
  • Reduce the risk of bones breaking
  • Reduce the level of calcium in your blood
  • Reduce pain

Bisphosphonate treatment can stop some types of cancer from spreading into the bone for some people. Studies have also shown that bisphosphonates can help some people with myeloma, secondary breast cancer, and secondary prostate cancer to live longer.

 

How bisphosphonates work

To understand how bisphosphonates work it helps to first know a bit about normal bone activity, and how cancer can affect this. There is information below about

Normal bone activity

Your bones are made of living tissue, and are constantly changing. In healthy bones, specialised bone cells constantly break down and replace bone tissue. These specialised bone cells are

  • Osteoclasts – which break down old bone
  • Osteoblasts – which build new bone

This process is called bone remodelling and is very well controlled. There is a fine balance between the rates of bone breakdown and growth, which keeps bones strong and healthy.

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How cancer affects bones

Myeloma and secondary bone cancers can spread into the bone, and damage it as they grow. Cancer cells that have spread to the bone also release proteins that interfere with the normal bone shaping process. These proteins are cytokines and growth factors.

The proteins stimulate the cells that break down bone (osteoclasts) and make them overactive. So bone is destroyed faster than it is rebuilt. This means your bones can become thinner and weaker, causing the following symptoms

  • Pain in the affected bone
  • High calcium levels in the blood
  • An increased risk of breaks (fractures)

Calcium is normally stored in the bones and the breakdown of bone cells releases more calcium than usual into the blood. Doctors call a high level of calcium in the blood hypercalcaemia. Symptoms of hypercalcaemia include

  • Feeling thirsty
  • Constipation
  • Feeling sick
  • Feeling drowsy

We have detailed information about high calcium levels and cancer.

What bisphosphonates do

Bisphosphonates target the areas of higher bone turnover. The osteoclast cells absorb the bisphosphonate drug, which slows down their activity and reduces bone break down.

There are several different types of bisphosphonates, and they each work slightly differently. Doctors are still learning more about the exact ways in which bisphosphonates work. We know that they can

  • Interfere with the formation of osteoclasts
  • Make osteoclasts self destruct, or die early
  • Change the signalling between osteoclasts and osteoblasts
  • Form a barrier between the bone and the osteoclast

Researchers have found that bisphosphonates can prevent or slow down the development of myeloma and secondary bone cancers in some people. Cancer cells appear to be attracted to an environment where bones are being broken down. Researchers hope that stopping this process could slow the growth of cancer and help people live longer, as well as reducing bone damage. There is information about bisphosphonate research lower down this page.

 

Types of bisphosphonates

There are several different types of bisphosphonates, including

You can have clodronate (Bonefos, Clasteon, Loron) as tablets or capsules. You have ibandronate (Bondronat) either or by drip into your vein (infusion) or as tablets. You have zoledronic acid (Zometa) and pamidronate (Aredia) as a drip. You can find out more about having these drugs, and their particular side effects, by using the links above for each drug.

Most of the research so far has looked at using bisphosphonates with secondary breast cancer, secondary prostate cancer and myeloma. The type of bisphosphonate your doctor prescribes for you will depend on the type of cancer you have. You will have one that works for your type of cancer.

There may sometimes be a choice of bisphosphonates for your type of cancer. Some studies have compared different types of bisphosphonates. Your doctor will give you the bisphosphonate best suited to your medical and practical needs. For example, you might prefer to take a bisphosphonate tablet at home rather than travel to hospital every month and have treatment by drip.

 

Research into bisphosphonates

You can find out about research trials results for bisphosphonates on our clinical trials database. Go to the advanced search and choose 'bisphosphonates' from the list of treatment types. Tick the boxes for closed trials and trial results.

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Updated: 3 June 2014