Managing metastatic bone pain: the role of bisphosphonates

Approximately two-thirds of patients with bone metastases have severe and debilitating pain. Despite a range of treatments, about 25% of patients with painful bone metastases suffer from uncontrolled pain. Bisphosphonates are the standard care for the reduction of skeletal events associated with bone metastases. We review the efficacy of currently available bisphosphonates in cancer-related bone pain. Oral clodronate, intravenous (i.v.) pamidronate, and i.v. zoledronic acid have shown an analgesic effect in some studies. Both i.v. and oral ibandronate reduced bone pain in breast cancer patients with bone metastases and maintained bone pain scores below baseline levels for up to two years in clinical trials. Pilot studies of intensive i.v. ibandronate dosing show rapid and effective relief from moderate-to-severe bone pain in patients with breast cancer and other tumors. Phase III trials are warranted to compare the efficacy of bisphosphonates in treating bone pain and to confirm the effects of intensive dosing regimens.