Treatment of metastatic bone disease in breast cancer: bisphosphonates

Like other metastases, bone metastases in breast cancer patients are not only a sign of the incurable nature of the underlying disease, but are also associated with specific complications. In particular, bone pain and pathological fractures impair the quality of life of those affected. Any treatment concept must, therefore, place the highest priority on preventing or reducing skeletal complications. There are two treatment options--local and systemic. Local therapy includes radiotherapy as well as surgical and orthopedic measures. The four pillars of systemic treatment are hormone therapy, chemotherapy, antiresorptive therapy with bisphosphonates, and treatment with centrally and/or peripherally acting analgesics. A precondition for successful treatment is close cooperation between medical/clinical oncologists, radiotherapists, surgeons/orthopedists, gynecologists, pain specialists, and endocrinologists (in the presence of a hypercalcemic syndrome). Patients with breast cancer associated solely with osseous metastasis may live for a number of years. It is, therefore, all the more important to start appropriate therapeutic measures early. Bisphosphonates play a particularly valuable role, since their main effect lies in the prevention of skeletal complications. Rather than replacing antineoplastic therapy, this class of substances supplements other treatments. Once started, bisphosphonate therapy should be given for the remainder of the patient's life, even in the event of osseous progression.