Bone-Strengthening Medicines for Bone Metastasis

Breast cancer that spreads to the bones is called bone metastasis. It’s possible to help strengthen and protect your bones and reduce damage caused by metastasis with bone-strengthening medicines that:

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  relieve bone pain

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  lower the risk of osteoporosis (weakened bones)

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  lower the risk of spinal cord compression

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  lower the risk of breaking a bone weakened by the tumor

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  lower high levels of calcium in the blood

The most common bone-strengthening medicines for bone metastasis are called osteoclast inhibitors.

Osteoclasts are bone cells that break down bone tissue. Osteoclast inhibitors interfere with the activity of osteoclasts. These medicines can delay serious bone problems such as fractures or spinal cord compression while making the bones stronger. The medicines can work in different ways, but they have similar effects.

Xgeva (chemical name: denosumab) is given monthly as an injection (a shot) under the skin.

Zometa (chemical name: zoledronic acid) is a type of medicine known as a bisphosphonate. Zometa requires an intravenous infusion — which is delivered directly into your bloodstream through an IV or a port — every three months.

There are some differences between Xgeva and Zometa:

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  Effectiveness: Xgeva is slightly more effective than Zometa at reducing the risk of complications from bone metastasis.

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  Treatment timing and frequency: Xgeva can be given more quickly than Zometa since it’s a single injection, but it must be given once a month. Zometa infusion takes more time, but it can be given less frequently. Research on the timing and frequency of these medicines is ongoing, so be sure to check with your doctor about how often you need to take them.

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  Cost: A generic version of Zometa is available, which may make a difference in terms of insurance coverage. If Zometa isn’t available, your doctor may prescribe another bisphosphonate called Aredia (chemical name: pamidronate).

Before starting any bone-targeted therapy, your doctor must make sure your levels of calcium and vitamin D aren’t too low. If they are, your doctor may recommend supplements before you begin the medicine or even during your bone-targeted therapy.

It’s important to know that Xgeva and Zometa are associated with a rare side effect called jaw osteonecrosis, in which the cells in the jawbone start to die. Doctors often advise stopping the medicine at least one month before having any dental work, including deep cleanings, fillings, and root canals. About two months after a dental procedure, you can start retaking the medicine. Even if you’re not having dental work, it’s a good idea to let your dentist know you’re taking one of these medicines in case you develop problems that need immediate attention.

Kidney problems are another rare side effect of bisphosphonates such as Zometa and Aredia. Your doctor may decide to follow your kidney function over time.