Bisphosphonates in the prevention and treatment of metastatic bone disease

Metastatic bone disease results from the many interactions between tumour cells and bone cells and causes disruption of normal bone metabolism. In addition to the known benefits of both external beam radiotherapy and systemic endocrine and cytotoxic treatments, it is now clear that the bisphosphonates provide an additional treatment strategy which reduces both the symptoms and complications of bone involvement. Ongoing research is aimed at trying to define the optimum route, dose, schedule and type of bisphosphonate, and their value in the adjuvant setting to inhibit the development of bone metastases and treatment-induced osteoporosis.