Regular Article
Metastatic bone disease: clinical features, pathophysiology and treatment strategies

https://doi.org/10.1053/ctrv.2000.0210Get rights and content

Abstract

Metastatic bone disease develops as a result of the many interactions between tumour cells and bone cells. This leads to disruption of normal bone metabolism, with the increased osteoclast activity seen in most, if not all, tumour types providing a rational target for treatment. The clinical course of metastatic bone disease in multiple myeloma, breast and prostate cancers is relatively long, with patients experiencing sequential skeletal complications over a period of several years. These include bone pain, fractures, hypercalcaemia and spinal cord compression, all of which may profoundly impair a patient’s quality of life.

External beam radiotherapy and systemic endocrine and cytotoxic treatments are the mainstay of treatment in advanced cancers. However, it is now clear that the bisphosphonates provide an additional treatment strategy, which reduces both the symptoms and complications of bone involvement. Ongoing research is aimed at trying to define the optimum route, dose, schedule and type of bisphosphonate in metastatic bone disease and in the prevention and treatment of osteoporosis in cancer patients. In vitro suggestions of direct anticancer activity and some promising clinical data in early breast cancer have resulted in considerable interest in the possible adjuvant use of bisphosphonates to inhibit the development of bone metastases.

References (54)

  • R.E. Coleman et al.

    Double-blind, randomised, placebo-controlled study of oral ibandronate in patients with metastatic bone disease

    Ann Oncol

    (1999)
  • A.T. van Holten-Verzantvoort et al.

    Reduced morbidity from skeletal metastases in breast cancer patients during long term bisphosphonate (APD) treatment

    Lancet

    (1987)
  • Rubens, R. D. Coleman, R. E. Bone metastases. Abeloff, M, DArmitage, J, OLichter, A, SNiederhuber, J, E, Clinical...
  • O.V. Batson

    The role of the vertebral veins in the metastatic process

    Ann Intern Med

    (1942)
  • G.H. Urwin et al.

    Generalised increase in bone resorption in carcinoma of the prostate

    Br J Urol

    (1985)
  • R.E. Coleman

    Biochemical markers of malignant bone disease

    Rubens RD, Mundy GR eds Cancer and the Skeleton

    (2000)
  • G. van der Pluijm et al.

    Tumour progression and angiogenesis in bone metastases from breast cancer: new approaches to an old problem

    Cancer Treat Rev

    (2000)
  • M.A. Eisenberger et al.

    Prognostic factors in stage D2 prostate cancer: important implications for future trials: results of a Co-operative Intergroup Study (INT 0036)

    Semin Oncol

    (1994)
  • R.A. Kyle et al.

    Multiple myeloma and related disorders

    Abeloff MD, Armitage JO, Lichter AS, Niederhuber JE eds, Clinical Oncology, 2nd edn

    (2000)
  • R.E. Coleman et al.

    Clinical course and prognostic factors following recurrence from breast cancer

    Br J Cancer

    (1998)
  • R.E. Coleman et al.

    The clinical course of bone metastases from breast cancer

    Br J Cancer

    (1987)
  • J.A. Kanis et al.

    Bisphosphonates in the treatment of multiple myeloma

  • A.R. Morton et al.

    Hypercalcaemia

  • H. Mirels

    Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathological fracture

    Clin Orthop Rel Res

    (1989)
  • L.D. Rodichok et al.

    Early detection of spinal epidural metastases: the role of myelography

    Ann Neurol

    (1986)
  • K.D. Harrington

    Spinal stabilisation

    Rubens RD, Mundy GR eds, Cancer and the Skeleton

    (2000)
  • Cited by (0)

    View full text