Patients with bone metastases may also benefit from drugs like Zometa or Aredia which inhibit osteoclastic bone resorption (see review here). There is some risk that these drugs can cause osteonecrosis of the jaw (go here and here).


Zoledronic acid (Zometa) versus pamidronate (Aredia) in the treatment of skeletal metastases in patients with breast cancer or osteolytic lesions of multiple myeloma: a phase III, double-blind, comparative trial.

Rosen LS. Cancer J 2001 Sep-Oct;7(5):377-87

Zoledronic acid, a new and more potent bisphosphonate, was compared with pamidronate, the current standard treatment for patients with osteolytic or mixed bone metastases/lesions. Zoledronic acid (4 mg) via 15-minute intravenous infusion was as effective and well tolerated as 90 mg of pamidronate in the treatment of osteolytic and mixed bone metastases/lesions in patients with advanced breast cancer or multiple myeloma.
Malignant cells secrete a multitude of factors that stimulate bone resorption, including PTH-rP, prostaglandin E, growth factors and cytokines. These factors may stimulate increased osteoclast activity or increased production of IL-1 or TNF by macrophages. Rationale for IV Bisphosphonate use Inhibits bone resorption due to potent inhibition of osteoclast hyperactivity
Proposed mechanisms of action include:
o Functional suppression of mature osteoclast
o Inhibition of osteoclast maturation
o Inhibition of osteoclast recruitment to the site
o Reduction in the production of IL-1 by macrophages
High affinity for calcium		 osteo2.gif (17008 bytes)