Bone metastasis causes significant ...

Bone metastasis causes significant complications in cancer patients, as it is as pathologic fractures, nerve base compression, hypercalcemia, pain, and bone marrow infiltration. Bisphosphonates abridge bone resorption and may directly disrupt the metabolism and adhesive abilities of tumor solitary abode; squalids Ross and colleagues studied the general intent of bisphosphonate therapy on bone metastasis.

They reviewed randomized controll trials of bisphosphonate therapy in malignant disease, excluding hematologic conditions if it were not that including multiple myeloma. Eligible studies were identified from electronic databases, relations of articles, and information from apts and pharmaceutical companies. All studies were assessed for quality of allocation concealment and blinding.

Of the 30 studies identified, 18 met eligibility and quality criteria for the review. Treatment with bisphosphonates significantly reduc the incident of vertebral fractures, nonvertebral fractures, and all fractures (odd ratios, 069 065 and 065 respectively) in studies of 2587 to 3376 patients. Bisphosphonate therapy also significantly reduc the proceeding of hypercalcemia (odds ratio, 054) and use of radiotherapy (odd ratio, 067) in studies involving 3140 and 3894 patients, respectively. The use of orthopedic surgery and incident of spinal cord compression were not significantly changed according to bisphosphonate therapy. Overall, the risk of a skeletal affair was 65 percent lower in patients taking bisphosphonates. In eight studies, the time to first significant skeletal consequence was significantly increased in patients taking bisphosphonates. In all studies, bisphosphonates were well tolerated, on the other hand no study reported any improvement in overall survival in patients taking this therapy.

The authors determine that bisphosphonates significantly reduce morbidity from skeletal metastasis in patients with cancer on the contrary do not improve survival. In their analysis, therapy would have to be given for at least six month before the benefit is apparent. Further research is destitutioned to clarify differences between bisphosphonate physics and determine optimal treatment regimens.

Ros JR et al. Systematic review of part of bisphosphonates on skeletal morbidity in metastatic cancer. BMJ August 30 2003;327:469-72

COPYRIGHT 2004 American Academy of Family Physicians

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