Monthly infusion of pamidronate 30 mg should be the recommended dose for prevention of bone disease in patients with multiple myeloma.
Lancet Oncol. 2010 Oct 1;11(10):973-982 (ABSTRACT Shown below on separate page)
As reported at the 08 annual International Scientific Assembly of the Am College of Chest Physicians' Meeting, Philadelphia, PA (October 08)
For patients who have osteoporosis, the use of bisphosphonates appears to increase the risk of serious atrial fibrillation, according to a meta-analysis.
The risk of atrial fibrillation leading to hospitalization or death was 68% greater in patients taking alendronate (Fosamax) or zoledronic acid (Reclast, Zometa) than in those taking placebo (OR 1.66, 95% CI 1.23 to 2.24), Jennifer Miranda, M.D., of the University of Miami in Florida, reported at the American College of Chest Physicians meeting here.
Data is 'preliminary' and FDA is examining this situation.
1/08 It is now completely accepted that osteonecrosis is an unwanted effect from bisphosphonates. Some have suggested that visiting a dentist and having one's teeth and gums treated PRIOR to treatment, may be one way to reduce risk.
10/06 Although we still occasionally see a paper suggesting this is an unproven connection, it seems most accept that bisphosphonates, like so many drugs, have complications.
5/31/04 The International Myeloma Foundation has issued a special advisory on
this potential complication of bisphosphonate therapy.
There is not
yet any conclusive evidence that bisphosphates can cause this
complication. Nevertheless, there have been enough cases reported to
prompt the FDA to require that it be added to the Aredia and Zometa
People taking bisphosphonates such as Aredia and Zometa should be aware
of this issue and be particular attentive to any dental problems and
catious about dental procedures.
to read the advisory.
You can find general information about bisphosphonate therapy at
8/03 HEADS UP on Possible Complications:
A woman from SHARE (NYC-based self-help group for those w/breast or ovarian cancer) told Helen S. that she developed renal problems when she was on Aredia.
Her oncologist, thinks it was caused by the interaction of Celebrex with Aredia. Apparently two other of his patients who were also taking both drugs also developed kidney problems. The woman said her kidney function is returning to normal but the doctor is worried about her developing kidney failure and does not want her to be on a bisphosphonate again. The dosage the woman was on was 800 mg a day. You might want to post this information online
From Helen S.
There is growing evidence that bisphosphonate drugs not only reduce bone pain and prevent tumor progression in cancer patients with bony metastases, but that they can reduce the size of metastatic tumors and possibly even prevent them.
But these drugs are not yet indicated for prophylactic use outside of study protocols, even though off-label use is common.
The latest data on bisphosphonates in cancer treatment were reviewed in presentations at the International Congress on Bone Metastases (ICBM), in Paris, France.
"At the moment, all the evidence is in animal models and cell line systems, but, consistently, these have shown that most of the bisphosphonates have effects on cell proliferation in breast cancer and in myeloma," said Robert E. Coleman, MD, a consultant medical oncologist in the Department of Clinical Oncology, University of Sheffield. "The more potent agents also can induce apoptosis and affect adhesion molecules in various metastatic processes."
He said these effects are seen at 10- to 100-micro-molar concentrations. These are higher than the doses indicated for treatment of osteoporosis, the original indication for bisphosphonates, but the higher drug levels are achievable close to the bone surface where metastatic destruction occurs.
"We need to wait for the ongoing clinical studies to show whether the newest bisphosphonates really do cause apoptosis, and hopefully we will have clinical evidence of this in the next six to 12 months," Dr. Coleman said.
Meanwhile, he said, bisphosphonates should only be used prophylactically in cancer patients in clinical trials, except, of course, in those who need these compounds for concomitant osteoporosis.
"Osteoporosis is a very common co-existing condition with cancer," Dr. Coleman said. For example, older women with breast cancer and older men with prostate cancer would be at risk for osteoporosis, he said. "And younger women who have had chemotherapy would have early menopause and, therefore, similar concerns about skeletal health," he added.
The osteoporosis dose of bisphosphonate tends to be lower than that used in cancer protocols, Dr. Coleman reiterated, but he added that the bisphosphonates have very mild toxicity profiles and there is little harm in giving higher doses for osteoporosis.
"One would not be doing any harm with regard to the cancer, and the hope would be that one might be doing some good," he said.
Ann's NOTE: This relatively non-toxic treatment can be given as a preventive measure. Show these articles to your doctor. Most oncologists are willing to use chemotherapy experimentally, why not these drugs? Bisphosphonates include Aredia (pamidronate) Zolodronate, clodronate (available as oral medication in Canada and Europe), also Fosomax. I have been interested in bisphosphantes since 1995.
Thanks to Doctor's Guide for this important information.
JCO, January 2001
Identifying Breast Cancer Patients at High Risk for Bone Mets
Intentional/Unintentional Weight Loss=Bone Loss
J Oral Maxillofac Surg, 5/04
Avascular Necrosis of the Jaws: Risk Factor in Ca Mets
Package Insert re Osteonecrosis & Bisphosphonates
Risk of Ostenecrosis in Cancer Pts
Summary of FDA Hearing (ODAC), March 4, 2005
Ltr to Editor: The Oncologist - From an Advocate
'Reduced' Schedule to Reduce Osteonecrosis
Personal Story of Recovery from Osteonecrosis of the Jaw
Every patient had loss, UNLESS
they used Tamoxifen or bisphosphonates
at the same time as chemo
Chemo Causes Rapid Bone Loss in Premenopausal Women
Essential Fatty Acids & Post-Meno Bone Loss
High Isoflavone Intake Increases BMD-Postmeno
CMF and Significant Loss in Clavicle-Pre-menopausal
Nursing Guidelines for Bisphosphonates
Osteonecrosis of the Jaws-Bisphophonate Use
Study from Sweden, 7/03
Older Adults and Dietary Issues
Oligosaccharides & Calcium Absorption/ Bone Resorption
Postmeno Women Ca/Potassium Inhibits Bone Resorption
Dietary Calcium Deficiency Promotes Breast Ca Tumor Growth in Bone
Nature, 8/8/01 via
WebMD Medical News
Low Electrical Field Mat to Treat Osteoporosis
Research on Vibrating 'Gym' Equipment
Low-level, High-frequency Mechanical Signals Enhance...
Cancer, July 2001
Zometa Reduces Bone Complications in Multiple Myeloma & Bca
BMD, then Vit D Therapy
Stop High-Caffeine Foods, Add Exercise
Fruit /Veg intake is Assoc w/Increased Bone Mass
Pamidronate & 1,24(S)-dihydroxyvitamin D-2 inhibited growth of cancer cells
Radiological Soc of NA
FDA Okays Radio Frequency Ablation for Bone Pain
Doctor's Guide (oral presentation)
Profound/Long-Lasting Negative Effects on Bone Marrow
Breast Cancer Res & Treatment, 6/02
Density of clavicle reduced in pre-meno pts
Adj Clodronate Improves Overall Survival: BCa w/Micro-mets
Aquatic & Land Exercises Improve Balance/Function
J Urol, 10/02
Ego Seeman, MD, Australia
Medscape 'Ask the Expert',
Against Teriparatide for Osteoporosis
Zinc Intake Useful in Osteoporosis: MEN
Br J Nutr, 6/03
Curr Opin Rheumatol, 7/03
Am Soc Thera Rad & Onc, 10/03
Osteoplasty: Injecting Medical-grade Bone Cement into Tumors
Single 8 gray Treatment RTX Palliative for Bone Mets
LINK to latest research,
information, tips to manage pain
Br J Nutri, 7/04
Am J Clin Nutr. May 2007
Magnesium & Zinc Spplmnttn - Beneficial Effects on Bone Density
Dietary Calcium to Prevent Bone Mets
Nutritional Zinc in the prevention of osteoporosis
Am J Clin Nutr, 2007; 86(4): 1243-7 September (?) 2007
Journal of Medicinal Food, February 2010
Lancet Onocol October 2010
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