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Zoledronic acid and denosumab reduce fractures, spinal cord compression and bone pain from bone metastases and myeloma, prevent treatment-induced bone loss, and in postmenopausal breast cancer modestly reduce recurrence in bone.
Pamidronate (1995, myeloma) and zoledronic acid (2002) reduce skeletal-related events by ~30-40%; denosumab (anti-RANKL, 2010) is superior to zoledronic acid for delaying SREs in solid tumours and non-inferior in myeloma, without renal dosing. Adjuvant bisphosphonates reduce bone recurrence and breast cancer mortality in postmenopausal women (EBCTCG 2015 meta-analysis: 3.3% absolute mortality reduction) and are guideline-recommended; denosumab did not improve disease outcomes adjuvantly (D-CARE). De-escalated dosing (12-weekly zoledronic acid, CALGB 70604) is standard. Osteonecrosis of the jaw (1-2%; dental review), hypocalcaemia, atypical femoral fractures and rebound vertebral fractures after stopping denosumab are the key harms. Also used for hypercalcaemia of malignancy and cancer-treatment-induced bone loss (aromatase inhibitors, ADT).
Inhibit osteoclast-mediated bone resorption (bisphosphonates via farnesyl pyrophosphate synthase in osteoclasts; denosumab by neutralising RANKL) to reduce the vicious cycle between tumour cells and bone turnover.
Denosumab is an injection under the skin that blocks the signal driving bone breakdown. As Xgeva it prevents fractures and other bone complications in people whose cancer has spread to bone or who have myeloma; as Prolia it treats osteoporosis, including bone loss caused by hormone therapy for breast and prostate cancer.
Ibandronic acid (Bondronat) is a bisphosphonate available in Europe as a monthly infusion or daily tablet to prevent fractures and other bone complications in women with breast cancer that has spread to bone, and to treat cancer-related high calcium.
Pamidronate (Aredia) is a bisphosphonate infusion approved in 1991 for dangerously high blood calcium in cancer and later for bone damage from myeloma and breast cancer, where it roughly halved skeletal complications. Its two-hour infusion, against fifteen minutes for zoledronic acid, pushed most centres to switch, though it is cheaper and may cause less jaw osteonecrosis.
Zoledronic acid (Zometa) is a fifteen-minute infusion given every few weeks or months to strengthen bone and prevent fractures, spinal cord compression and the need for radiotherapy in people with myeloma or cancer that has spread to bone; it also treats dangerously high calcium caused by cancer.
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One technology page and one term page on OnCo cite this paper by its DOI; this record gives the citation a page of its own so a reader can follow it without leaving OnCo. Read the abstract above alongside the citing pages listed under Related; the record was created automatically from the Europe PMC entry and its figures have not been checked by hand.
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