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Management of Metastatic Bone Disease in the Elderly with Bisphosphonates and RANKL Inhibitors: Effectiveness and Safety

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Bone Metastases

Part of the book series: Cancer Metastasis - Biology and Treatment ((CMBT,volume 21))

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Abstract

In the last decades life expectancy of western populations has increased considerably, resulting in a steep rise in the number of elderly patients diagnosed with cancer. Metastatic bone disease (MBD) is a major concern in such patients since it may be associated with the development of skeletal related events (SREs) including fractures and cord compression. These complications may deteriorate the quality of life (Qol) of affected patients and also reduce expected survival. Due to the fact that in elderly patients there is an increased risk for the development of SREs, maintaining bone health and using effective therapies for MBD is of vital importance. Through numerous clinical trials Bisphosphonates (Bps) have proved to be effective in reducing the risk for SREs significantly in patients with MBD. Moreover, they have shown to decrease pain and improve Qol of treated patients. In elderly patients Bps should be used with caution since their use may cause serious complications such as renal function deterioration. Denosumab is a monoclonal antibody that targets and inhibits RANKL and has shown superiority over zoledronic acid in decreasing the risk of SREs. The elimination of denosumab is done through the immunoglobulin clearance pathway through the reticuloendothelial system and does not to affect renal function. It can therefore be safely used in the elderly. Osteonecrosis of the jaws (ONJ) is a serious complication that may develop after treatment with either denosumab or zoledronic acid. The incidence rates between the two were reported to be comparable. In order to decrease the risk of renal function deterioration or ONJ all preventive measures and treatment guidelines should be followed with caution. In this review article we comment on the effectiveness and safety of Bps and denosumab in elderly patients and discuss all indicated measures that should be implemented for minimizing the risk of potential complications. Several studies have investigated the cost effectiveness of denosumab versus zoledronic acid in terms of SRE prevention. These studies reported contradictory results mainly due to the application of different analytical perspectives and model parameters.

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Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Bank of Cyprus Oncology Centre, 32 Acropoleos Av, 2006, Nicosia, Cyprus

    Vassilios Vassiliou M.D., Ph.D.

  2. Department of Medical Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus

    Panteleimon Kountourakis M.D., Ph.D.

  3. Department of Radiation Oncology, University of Patras Medical School, Patras, Greece

    Dimitrios Kardamakis M.D., Ph.D.

Authors
  1. Vassilios Vassiliou M.D., Ph.D.
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  2. Panteleimon Kountourakis M.D., Ph.D.
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  3. Dimitrios Kardamakis M.D., Ph.D.
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Correspondence to Vassilios Vassiliou M.D., Ph.D. .

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Editors and Affiliations

  1. Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus

    Vassilios Vassiliou

  2. Dept. Radiation Oncology, University of Toronto Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

    Edward Chow

  3. Dept. Radiation Oncology, University of Patras Medical School, Patras, Greece

    Dimitrios Kardamakis

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Vassiliou, V., Kountourakis, P., Kardamakis, D. (2014). Management of Metastatic Bone Disease in the Elderly with Bisphosphonates and RANKL Inhibitors: Effectiveness and Safety. In: Vassiliou, V., Chow, E., Kardamakis, D. (eds) Bone Metastases. Cancer Metastasis - Biology and Treatment, vol 21. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7569-5_20

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