The local production of a variety of cytokines by metastatic cells and the bone microenvironment stimulates osteoclast activation and is the crucial event in bone destruction in cancer patients. Skeletal metastases are often associated with pain, pathological fractures, spinal cord compression and hypercalcemia and have a great impact on the quality of life. Bisphosphonates can reduce the bone resorption by inhibition of osteoclast activity. Large randomized clinical trials have shown the efficacy of bisphosphonates in reducing the frequency of skeletal events and pain in patients with multiple myeloma or breast cancer who have established osteolytic bone disease. In most trials, bisphosphonates were given to patients receiving cytotoxic or hormonal treatment. A new approach in bisphosphonate therapy is an earlier administration of the drug before osteolysis appears. Recent results indicate that early intervention with bisphosphonates in adjuvant treatment of high-risk breast cancer may reduce distant metastases and prolong overall survival in certain subgroups of patients. A randomized trial which addresses the role of bisphosphonates in stage I myeloma patients will be initiated by the German Myeloma Study Group.

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© 1999 S. Karger GmbH, Freiburg
1999
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