WHAT ARE BONE-TARGETING MEDICINES?

When cancer from a solid tumor has spread to your bones, your doctor may prescribe a bone-targeting medicine. Bone-targeting medicines are used to help prevent serious bone problems caused by bone metastases. They are prescribed to people with many types of cancers such as breast, prostate, and lung cancers.1

Bone-targeting medicines are not appropriate for all patients. Ask your doctor if one is right for you.

HOW DO BONE-TARGETING MEDICINES WORK?

Some cells in your body remove old bone while other cells build new bone. This ongoing process is part of what keeps your bones strong. When cancer spreads to the bones, the cells that remove old bone can become overactive. This can make bones weaker and increase the risk for serious bone problems.2 Serious bone problems are defined as broken bones (fractures), a need for surgery to prevent or repair broken bones, a need for radiation treatments to the bone, or pressure on the spinal cord (spinal cord compression).3 Bone-targeting medicines work by "turning off" the cells that remove old bone–meaning that the medicine slows down the bone removal process.2

 

HOW ARE BONE-TARGETING MEDICINES GIVEN?

Most bone-targeting medicines are given by a shot or an intravenous (IV) infusion. These medicines are administered in your doctor's office, usually about once every 3 to 4 weeks.2

WHAT ARE SOME OF THE RISKS ASSOCIATED WITH BONE-TARGETING MEDICINES?

Do not take bone-targeting medicines if you have low blood calcium (hypocalcemia) or are allergic to any of the ingredients in the medicine. Call your doctor or go to the nearest emergency room right away if you have any symptoms of a serious allergic reaction, including:

  • Low blood pressure (hypotension)
  • Trouble breathing
  • Throat tightness
  • Swelling of the face, lips, or tongue
  • Rash, itching, or hives

Some of the possible side effects of bone-targeting medicines include low calcium levels in your blood (hypocalcemia), which could be life-threatening, severe jaw bone problems (osteonecrosis), unusual thigh bone fractures (atypical femoral fracture), and possible harm to your unborn baby.2

  • Unusual thigh bone fractures (atypical femoral fractures) can occur while taking bone-targeting medicines. Symptoms can include new or unusual pain in your hip, groin, or thigh.4,5
  • Possible harm to your unborn baby: Bone-targeting medicines may harm your unborn baby. Tell your doctor right away if you are pregnant, plan to become pregnant, or suspect you are pregnant.

If you are already on a bone-targeting medicine and you experience these or any other unusual symptoms, contact your doctor.

 

WHAT IS ONJ?

Osteonecrosis (pronounced OSS•tee•oh•ne•KRO•sis) of the jaw (ONJ) involves serious bone damage in the jaw. ONJ may occur during treatment with some bone-targeting medicines.2

 

CONTACT YOUR DOCTOR IF YOU EXPERIENCE2,6,7:

  • Symptoms of ONJ, which may include jaw pain, numbness, and swelling of or drainage from the jaw, mouth, or teeth
  • Persistent pain or slow healing of the mouth or jaw after dental surgery

ORAL HYGIENE AND ONJ RISK2,6

Remember to practice good dental care if your doctor has prescribed bone-targeting medicines. You may want to have a dental exam before you begin therapy, and then focus on your dental health throughout treatment.

While you are taking a bone-targeting therapy:

  • Maintain a good oral hygiene routine
  • Tell your dentist if you are on a bone-targeting agent
  • Avoid invasive dental procedures while on treatment

Talk with your doctor for more information about how a bone-targeting medicine may impact the health of your mouth or jaw.

REFERENCES:
  1. Coleman R, Body JJ, Aapro M, Hadji P, Herrstedt J; ESMO Guidelines Working Group. Bone health in cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2014;25(Suppl 3):iii124-iii137.
  2. American Cancer Society. Bone metastasis. American Cancer Society website. http://www.cancer.org/acs/groups/cid/documents/webcontent/003087-pdf.pdf. Revised February 17, 2014. Accessed May 5, 2015.
  3. American Cancer Society. Advanced cancer. American Cancer Society website. http://www.cancer.org/acs/groups/cid/documents/webcontent/003082-pdf.pdf. Revised March 6, 2014. Accessed May 5, 2015.
  4. Donnelly E, Saleh A, Unnanuntana A, Lane JM. Atypical femoral fractures: epidemiology, etiology, and patient management. Curr Opin Support Palliat Care. 2012;6(3):348-354. 
  5. Drampalos E, Skarpas G, Barbounakis N, Michos I. Atypical femoral fractures bilaterally in a patient receiving denosumab. Acta Orthop. 2014;85(1):3-5.
  6. Ruggiero SL, Dodson TB, Fantasia J, et al. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw2014 update. J Oral Maxillofac Surg. 2014;72(10):1938-1956.
  7. Campisi G, Fedele S, Fusco V, Pizzo G, Di Fede O, Bedogni A. Epidemiology, clinical manifestations, risk reduction and treatment strategies of jaw osteonecrosis in cancer patients exposed to antiresorptive agents. Future Oncol. 2014;10(2):257-275.