Bisphosphonates and cancer
Bisphosphonates are drugs that help to strengthen bones and reduce the risk of bones breaking. They can help to prevent or slow down bone thinning (osteoporosis). They are also sometimes used to treat a high level of calcium in the blood (hypercalcaemia).
Bisphosphonates can also help to reduce pain from cancer that has spread to the bone. They can help to treat some types of cancer that cause bone damage.
Doctors also use a drug called denosumab as a bone targeted treatment. It’s a type of targeted therapy called a monoclonal antibody.
Cancers that can affect bones
Most cancers that affect bones are ones that have started in another part of the body and have spread to the bone (secondary bone cancer). The most common types are breast cancer, prostate cancer and lung cancer.
Myeloma develops from cells in the bone marrow called plasma cells. Bone marrow is the spongy tissue found inside the inner part of some of our large bones.
Some types of cancer treatment can also affect the bones making them weaker, this includes chemotherapy and hormone therapies.
How does cancer affect bones?
Cancers that spread to the bones damage the bones as they grow. The cancer cells that have spread into the bones 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's rebuilt.
This means your bones can become thinner and weaker, causing:
- 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
- feeling sick
- feeling drowsy
- abdominal pain
- bone 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 breast cancer and myeloma to live longer.
Bisphosphonates might also help to:
- prevent or control bone thinning (osteoporosis)
- reduce the risk of bones breaking
- reduce the level of calcium in your blood
- reduce pain
Types of bisphosphonate
There are several different types of bisphosphonate, including:
- disodium pamidronate
- ibandronic acid or ibandronate (Bondronat)
- sodium clodronate (Clasteon, Loron)
- zoledronic acid or zoledronate (Zometa)
You can have sodium clodronate as tablets or capsules. You have ibandronic acid as a drip into your bloodstream (infusion) or as tablets. And you have zoledronic acid and disodium pamidronate as a drip into your bloodstream.
Most of the research so far has looked at using bisphosphonates in 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.
You might have bisphosphonate treatment if you have myeloma to:
- slow down or prevent bone disease
- treat the symptoms of myeloma such as bone pain or high levels of calcium
- treat myeloma if you have bone damage
This is usually:
- zoledronic acid
- disodium pamidronate, if you can’t have zoledronic acid for some reason
- sodium clodronate, if you can’t have zoledronic acid or disodium pamidronate for some reason
You might have bisphosphonate treatment if you’re having hormone therapy and have osteoporosis (thinning of the bones). If you can’t have bisphosphonates for any reason you might have denosumab.
Bisphosphonates are not recommended to try and prevent prostate cancer that hasn’t spread, spreading to the bone.
Advanced prostate cancer
You might have bisphosphonate treatment if you have advanced cancer and hormone treatment is no longer controlling your cancer. This aims to prevent or reduce problems with your bones. You are likely to have zoledronic acid.
You might have bisphosphonates as tablets or an injection into the vein for pain relief in one of the following situations:
- you have advanced cancer and hormone treatment is no longer controlling the cancer
- other treatments, including painkillers and radiotherapy, have not helped your pain enough
For some women, bisphosphonate treatment can help reduce the risk of their breast cancer spreading to the bones. And improve some women’s chance of surviving their cancer.
You might have bisphosphonate treatment alongside your cancer treatment if:
- you have early and locally advanced breast cancer, with cancer in the nearby lymph nodes
- and you are postmenopausal
Or you might have this treatment if all of the following apply:
- have locally advanced breast cancer, which isn’t in the nearby lymph nodes
- are postmenopausal
- are at high risk of your cancer coming back after treatment
For these women, the bisphosphonates recommended are:
- zoledronic acid into a vein, usually every 6 months given at the same time as chemotherapy, for 3 years
- sodium clodronate, as a tablet for 3 years – if you can’t have zoledronic acid for some reason
You might also have bisphosphonates if you:
- have breast cancer that has spread to the bones, to try and prevent any bone problems and reduce pain
- have, or are at high risk of, bone thinning (osteoporosis)
You can find a clinical trial looking at bisphosphonates and cancer on our clinical trials database. Click on the ‘recruiting’, ‘closed’ and ‘results’ tabs to make sure you see all the trials.