Fast Five Quiz: Metastatic Bone Disease Management

Maurie Markman, MD


March 27, 2019

Radiation, calcium metabolism modifiers (also referred to as "osteoclast modifiers"), and monoclonal antibody therapies are additional management options for patients with MBD. Spinal radiation therapy helps nearly 95% of patients with spinal metastases remain ambulatory, and can sometimes also improve patients' neurologic function.

Calcium metabolism modifiers, such as intravenous bisphosphonate therapy, prevent osteoclast attachment to the bony matrix and inhibit osteoclast recruitment and survival.

Denosumab, a monoclonal antibody therapy that regulates osteoclast production, is approved by the US Food and Drug Administration (FDA) to prevent skeletal-related events in patients with MBD. Denosumab is also FDA-approved to reduce skeletal-related events in patients with multiple myeloma and cancer metastases from solid tumors. It is also indicated for female patients with breast cancer who have associated aromatase inhibitor-induced bone loss and in men with prostate cancer who have associated androgen deprivation-induced bone loss.

The primary management goals for patients with MBD are palliative and include treatment to maintain ambulation and control pain. Issuing bedbound orders and treating patients with acetaminophen are not optimal management options for patients with MBD.

Meperidine is contraindicated in patients with MBD owing to serious side effects, including seizure.

Limb amputation is not typical management for patients with MBD.

For more on treatment and management options for patients with MBD, read here.


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