Pathogenesis and Bisphosphonate Treatment of Skeletal Events and Bone Pain in Metastatic Cancer: Focus on Ibandronate

Bone metastases are the most common cause of pain in patients with advanced cancer, and are associated with progressive skeletal destruction, spinal problems, and hypercalcaemia. Radiotherapy, analgesia, and surgery are the accepted treatment options for chronic malignant bone pain, with a stepped approach being generally recommended. In the past decade, the bisphosphonates, which reduce bone turnover, increase bone mass, and decrease the risk of fracture, have become established as an effective treatment in patients with cancer metastasising to bone. The nitrogen-containing bisphosphonate, ibandronate, has been shown to reduce the risk of skeletal events after oral or intravenous administration in controlled clinical trials in various malignancies, and to confer significant palliation of bone pain and improvements in health-related quality of life in patients with metastatic breast cancer, in particular. Tolerability of this agent has been good, with very low frequencies of acute-phase reactions and osteonecrosis of the jaw, and no evidence of acute nephrotoxicity.