[Things worth knowing about drug-based osteoprotection in uro-oncology]

Bone metastases in uro-oncology bear a high risk for bone-related complications (skeletal-related events, SRE). The presence of SRE is associated with an increased risk for death, which is markedly increased in the presence of pathological fractures. Prostate cancer and renal cell carcinoma in particular result in bone metastases in advanced stages. The SREs also represent an economic problem and lead to nearly double the costs of treatment. Zoledronic acid and denosumab are both approved osteoprotective drugs for the prevention or delay of SRE in metastatic disease. Interestingly, zoledronic acid does not reduce the incidence of SRE in hormone-sensitive prostate cancer. The dosage and administration of both drugs differ in the treatment of bone metastases and treatment or prophylaxis of osteoporosis. Long-term treatment with one of these two drugs is associated with the risk of development of medication-related osteonecrosis of the jaw (MRONJ). Routine controls of the oral cavity before and during treatment are mandatory in these patients.