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Bisphosphonates in multiple myeloma

Multiple myeloma (also known as myeloma or plasma cell myeloma) is a B‐cell malignancy or, more precisely, plasma cell neoplasm. This cancer grows inside or outside of bones. The bone damage, or osteolytic lesions, may lead to fractures of the long bones or compression fractures in the spine. The mechanism of bone destruction appears to be related to increased bone resorption by cells called osteoclasts. Bisphosphonates are drugs that can inhibit bone resorption by reducing the number and activity of osteoclasts. This updated review of 20 trials enrolling 6692 patients shows that adding bisphosphonates to myeloma treatment reduces fractures of the vertebra and bone pain. Zoledronate is better than etidronate and placebo alone, but not superior to pamidronate or clodronate for improving overall survival and any other outcomes such as vertebral and nonvertebral fractures.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Bone agents for breast cancer

When breast cancer (BC) has spread to the bones (bone metastases, BM), bone agents (added to anti‐cancer treatment for breast cancer) can reduce pain, fractures and other bone problems. Women and men with advanced breast cancer (ABC) commonly develop bone metastases. Cancer in bones can cause pain, fractures, hypercalcaemia (too much calcium in the blood) and tumour compression of the spinal cord, resulting in serious and permanent nerve damage. This is because cancer deposits can erode into bone using bone‐absorbing cells. Bisphosphonates, and the more recent novel targeted‐therapy denosumab, are drugs that reduce the activity of these bone‐absorbing cells. This review of trials in women with advanced BCBM found that the use of bisphosphonates or denosumab (in addition to their other cancer treatments), can reduce these serious bone problems. It is of great interest to see if bisphosphonates prevent recurrence and improve survival for patients who have been treated for early breast cancer (EBC). However, this review of trials in women with EBC has not identified a benefit of bisphosphonates as an adjuvant therapy at this stage. We have to wait for the reporting of a number of large clinical trials before firm conclusions can be made. Adverse effects are not common for bisphosphonates and include mild gut reactions, transient fever, hypocalcaemia and a small risk of osteonecrosis of the jaw (ONJ), depending on which drug is used. Denosumab appears to be at least as well tolerated as the bisphosphonates.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Bisphosphonate therapy for children and adolescents with secondary osteoporosis.

‐ may not lead to any difference in bone mineral density (bone thickness and strength).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Bisphosphonate therapy for osteogenesis imperfecta

Osteogenesis imperfecta is also known as brittle bone disease. It is a genetic condition which can be passed on from a parent to child or occur in the child without any other family history. An affected person is at risk for frequent breaks of the long bones or collapse of the vertebral bones. There is no cure for osteogenesis imperfecta and treatment is mostly supportive. This review looked at trials studying one of the groups of medications known as bisphosphonates which are more typically used to treat osteoporosis. They are used in osteogenesis imperfecta to try and reduce the number of bone fractures in affected individuals.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Drug treatments for pain in children and young people with life‐limiting conditions

Pain is commonly experienced in children and young people with diseases that are not curable and which may shorten their lives. These may be cancers or other diseases. Sometimes the pain is under‐treated, particularly for those nearing the end of their lives. There are many different types of drugs that have been developed to treat pain. There are also drugs that were not developed primarily to treat pain but which have an action that may provide pain relief. However, clinical guidelines to support doctors in their choice of treatment for pain are limited. This is because there are few trials specifically in children and young people that have tested the benefits and safety of such drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Cancer Pain (PDQ®): Patient Version

Expert-reviewed information summary about pain as a complication of cancer or its treatment. Approaches to the management and treatment of cancer-associated pain are discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: January 22, 2016

Langerhans Cell Histiocytosis Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of childhood Langerhans Cell Histiocytosis.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: October 30, 2015

Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®): Patient Version

Expert-reviewed information summary about oral complications, such as mucositis and salivary gland dysfunction, that occur in cancer patients treated with chemotherapy or radiation therapy to the head and neck.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: January 22, 2016

Bisphosphonates for osteoporosis in people with cystic fibrosis

Cystic fibrosis is a serious genetic disorder that affects many organs (e.g. lung and pancreas). It commonly leads to reduced bone mineral density, known as osteoporosis, which increases the likelihood of fractures. The short‐term and long‐term effects of fractures (e.g. rib and vertebral) may make lung disease worse. Bisphosphonates are drugs that increase bone mineral density by slowing down bone resorption. They are used to treat osteoporosis caused by menopause or the use of corticosteroid drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

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