Bisphosphonates for metastatic bone disease: A therapeutic rationale

Metastatic bone disease is a common clinical occurrence in patients with advanced malignancy. Bisphosphonates target the underlying pathophysiology of skeletal metastases by inhibiting the activity of osteoclasts reducing bone turnover. By effectively reducing skeletal complications and improving patient quality of life, mobility and functioning, bisphosphonates have become a standard of care in this indication. Currently, most patients with metastatic bone disease are managed with intravenous (i.v.) bisphosphonates infused every 3-4 weeks. This requires regular hospital treatment and close patient monitoring for renal adverse events. Although daily oral bisphosphonate therapy is available as an alternative to i.v. dosing, its clinical utility is compromised by unpleasant gastrointestinal side effects and dosing inconvenience. The third-generation bisphosphonate ibandronate has been formulated as an i.v. and an oral therapy for the management of metastatic bone disease. Clinical trial data demonstrated that ibandronate reduces the risk of skeletal complications, relieves bone pain, improves quality of life and is well tolerated in patients with bone metastases from breast cancer. The availability of ibandronate will widen bisphosphonate treatment options for metastatic bone disease.