[Biphosphonates as directed therapy in bone metastases]

The purpose of this revue is to estimate objectively the effect of bisphosphonates on the treatment of malignant bone metastases according to the literature revues. The most of malignant tumors metastases to bones, breast and prostate cancer and myeloma predominantly. The complications of these metastases, pathologic fractures, pain, immobility, spine compression, decrease the quality of life of the patients. Bisphosphonates, analogues of natural pyrophosphate, have been introduced as a standard systemic therapy modality for the treatment of bone metastases and its complications. Bisphosphonates are proved to have a palliative effect demonstrated in decrease and delay of bone metastases complications, and in such a way the increasing of patient's quality of life, but without the survival prolongation proved so far. Bisphosphonates are the best therapeutic for osteolytic hypercalcemia. Because of their still high price, bisphosphonates are limited accessible for a large use, even more in economic developed countries. For the rational use of national resources, it is advisable to accept the American Society of Clinical Oncology (ASCO) recommendations given for the use of bisphosphonates.

Bisphosphonates have a considerable palliative effect in most of the patients with bone metastases, but without a survival prolongation benefit. Further investigations are needed to find out when to start, and when to stop with the therapy, how to integrate it with the other modalities of the treatment, the use of bisphosphonates in an adjuvant setting for the prevention of bone metastases, accounting cost-benefit ratio.