Bisphosphonate drugs significantly reduce the likelihood of complications such as fractures and hypercalcemia in patients with cancer that has metastasized to bone, according to an article in the British Medical Journal.

British researchers identified 30 studies that lasted at least 6 months and analyzed their findings regarding complication and survival rates. All of the studies were randomized controlled trials of patients with confirmed cancer that had metastasized to bone. With the exception of multiple myeloma, all primary diagnoses were nonhematologic malignancies. The active treatment was either oral or intravenous bisphosphonate in comparison with another bisphosphonate, placebo, or standard care.

Patients who were treated with a bisphosphonate agent rather than placebo months were significantly less likely to sustain a fracture, develop hypercalcemia, or require radiation therapy: Risk was reduced to 65 percent of that for the placebo group for nonvertebral fracture, 69 percent for vertebral fracture, 54 percent for hypercalcemia, and 67 percent for radiation therapy.

A reduction in need for orthopedic surgery was seen in patients treated for over a year. No change in rate for spinal cord compression was observed at either duration of treatment.

Although bisphosphonate use in general significantly increased the time to a first bone-related event, it did not increase survival.

Subanalyses of the data suggest that the optimal treatment is initiation of intravenous therapy with an aminobisphosphonate agent (such as pamidronate and zoledronic acid) when metastases are diagnosed with continuation until there is no longer clinical relevance for the individual patient.