Bone health and Bisphosphonates

What are bisphosphonates?

Bisphosphonates are drugs which protect your bones. They slow down the process that breaks down bone.

There are three groups of people for whom doctors often prescribe bisphosphonates as part of their standard practice:

People with osteoporosis and other bone diseases – prescribed by their GP
People taking an aromatase inhibitor who are at high risk of osteoporosis – prescribed by their Surgeon or Medical Oncologist
People with cancer that has spread to their bone – prescribed by their Medical oncologist

For about 20 years, people with different types of cancer (not just breast cancer) whose cancer has already spread to the bone have been prescribed bisphosphonates. Its purpose for these secondary cancer patients is to reduce bone damage caused by their cancer and to prevent fractures. Ibandronic acid, Risedronate and zoledronic acid are all currently used to help prevent this damage.

Breast Cancer Protection from bisphosphonates

In July 2015 a study was published which looked at the risks and benefits of giving women with early (or primary) breast cancer bisphosphonates after their main treatment (usually surgery) as well as standard chemotherapy and hormone treatments. It analysed the results of a large number of previous studies which looked at the role of bisphosphonates in reducing the spread of breast cancer to the bones.

This new study found that, for some women, bisphosphonates can lower the risk of their breast cancer spreading to the bone.

They can be effective for women who:
have been diagnosed with early breast cancer of any type
have already gone through the menopause or have had treatment to stop their ovaries from functioning.

For women who met these criteria, bisphosphonates prevented:

1 in 3 recurrences of breast cancer in the bone
1 in 6 deaths from breast cancer 10 years after diagnosis

Are bisphosphonates routinely available? Yes in Bradford

Here at the Yorkshire breast Clinic we recommend using Risedronate 35mg once per week.

Mr Rick Linforth who has significant experience with the use of bisphosphonates thinks that all newly-diagnosed post-menopausal women who might benefit from bisphosphonates should be offered them to lower the risk of their disease spreading.

Women taking bisphosphonates to lower the risk of breast cancer spread to their bones usually take them for three years.

Do bisphosphonates have side effects?

Bisphosphonates generally have few side effects and, because they are not new drugs, health professionals know how to manage any side effects if they do appear. Serious side effects are rare.

Possible side effects include:

Inflammation and ulceration of the oesophagus (food pipe)
Nausea
Stomach pains
Inflammation of your tongue
Joint pain

Rare side effects that may be linked to both these drugs include:

Osteonecrosis of the jaw (ONJ) - a condition where some cells in your jawbone die. To lower your risk of ONJ if you are taking bisphosphonates, you should have regular dental check-ups and talk to your oncologist if you need dental treatment. However, ONJ is more likely in people taking high doses of bisphosphonates and high doses aren’t prescribed as part of this treatment.
Osteocronosis of the auditory canal in your ear (very rare – fewer than 1 in 10,000 people affected)

Different bisphosphonates each carry the risk of different side effects. If your oncologist recommends bisphosphonates for you, you can discuss how they may affect you. They will also advise which possible side effects need urgent advice from your oncologist or GP