Bisphosphonates for bone pain
This page tells you about bisphosphonates for bone pain in prostate cancer. There is information about
Bisphosphonates are drugs that can help to slow down the destruction of bone by cancer cells. They are mainly used to treat the bone thinning disease osteoporosis. But they have also been used to treat the symptoms of secondary cancers in the bones, particularly a condition called hypercalcaemia, where the level of calcium in the blood gets too high.
In healthy bones, bone tissue is constantly being broken down and replaced. Cancer that has spread to the bones encourages the breakdown of too much bone. This weakens the bones, making fractures more likely. It also causes pain and an increase in the level of calcium in the blood. Too much calcium causes drowsiness, sickness and thirst.
For some time now, bisphosphonates have been used to treat bone pain in secondary breast cancer and advanced prostate cancer. Studies have found that bisphosphonates can reduce pain and fractures in breast cancer and prostate cancer that has spread to the bone.
A bisphosphonate called zoledronic acid (Zometa) is licensed in the UK for treating prostate cancers that have spread to the bones. It is most commonly used when hormone therapy has stopped working. Prostate cancer that has stopped responding to hormone therapy is called hormone refractory prostate cancer. In this situation, zoledronic acid can help to reduce pain, and can improve quality of life (and possibly also survival) by lowering the number of fractures and spinal cord problems that men with bone secondaries may have.
You have to go to hospital to have zoledronic acid as it is given through a drip into a vein. But you can usually have it as an outpatient. The treatment has to be repeated every 3 to 4 weeks. Some studies are looking at just giving 1 or 2 treatments a year though. Other bisphosphonates include ibandronate and clodronate. Clodronate and ibandronate can be taken at home as a tablet or capsule or you can have them by drip into a vein.
Bisphosphonates can sometimes prevent cancer spreading to the bone and can prevent fractures if the cancer has already spread to the bone. But the National Institute for Health and Clinical Excellence (NICE) say that at the moment there is not enough evidence to use bisphosphonates in this way. They say that bisphosphonates should only be used to control pain from bone secondaries in prostate cancer, and only if other treatments, such as painkillers or radiotherapy, are not working.
There are trials looking at using other types of bisphosphonates in advanced prostate cancer. You can find information about this on the bisphosphonate section of our prostate cancer research page.
Bisphosphonates can have side effects. Make sure you ask your doctor what the side effects of any bisphosphonate treatment are likely to be. Zoledronic acid can cause tiredness, muscle aches and anaemia. We have information about the side effects of Zometa in our section about cancer drugs. In recent years doctors have seen that a small number of patients being treated with bisphosphonates into a vein have developed jaw problems. Bone tissue in the jaw has been destroyed. This is called osteonecrosis of the jaw and we have more information about it on CancerHelp UK. But it affects only a few patients having this treatment.
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