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Medications used in people with bone metastasis include:

1. Bone-forming drugs: Drugs commonly used to treat people with thin bones (osteoporosis) may also help people with bone metastases [1]. These medicines can strengthen the bones, reduce the pain caused by bone metastases, and reduce the need for powerful painkillers. Bone-forming drugs can also reduce the risk of developing new bone metastases. These medicines can be given via a vein in the arm or by injection every few weeks. Oral forms of these drugs are available, but they are generally less effective than intravenous or injectable forms and can cause gastrointestinal side effects. Bone-forming drugs can cause temporary bone pain and kidney problems. Rarely, there is an increased risk of severe jawbone deterioration (bone necrosis).

2. Intravenous radiation: People with multiple bone metastases can be given a form of radiation called radiopharmaceuticals from the veins. Radiopharmaceuticals use a small amount of radioactive material that has a strong attraction to bones. Once inside the body, the particles move to the area of bone metastases and emit radiation. Radiopharmaceuticals help control the pain caused by bone metastases. Side effects can include bone marrow damage, which can lead to lower blood cell counts.

3. Chemotherapy: If the cancer has spread to multiple bones, your doctor may recommend chemotherapy. Chemotherapy goes through your body to fight cancer cells. Chemotherapy can be taken as tablets, given intravenously, or both [2]. Side effects depend on the particular chemotherapeutic drug you are receiving. For cancers that respond to chemotherapy, chemotherapy may be the best way to reduce the pain caused by bone metastases.

4. Hormone therapy: For cancers that are sensitive to hormones in the body, treatment that suppresses those hormones may be an option. Breast and prostate cancers are often sensitive to hormone blockade therapy. Hormone therapy may include taking medications that lower natural hormone levels or interfere with the interaction of hormones with cancer cells. Another possibility is the surgical removal of hormone-producing organs (ovaries and testicles).

5. Painkillers: Painkillers can reduce the pain caused by bone metastases. Analgesics can include over-the-counter analgesics or more potent prescription analgesics. It may take some time to determine which combination of painkillers is best for you [3]. Tell your doctor if you are still taking the medicine and still have pain. Pain specialists may be able to offer options to relieve additional pain.

6. Steroids: Drugs known as steroids often help reduce the pain associated with bone metastases by reducing swelling and inflammation around the cancer site. These steroids are different from the types of steroids that bodybuilders and athletes use to build muscle. Steroids can act fairly quickly to relieve pain and prevent some cancer complications, but they have side effects and should be used very carefully, especially when used for long periods of time.

7. Targeted therapy: Targeted drug therapy focuses on specific abnormalities in cancer cells. By blocking these abnormalities, targeted drug treatment can lead to the death of cancer cells.

Certain cancers may respond very well to these treatments. For example, breast cancer cells that are HER2 positive can respond to certain medications.

External radiation therapy

Radiation therapy uses high-energy rays such as x-rays and protons to kill cancer cells. Radiation therapy may be an option if bone metastases cause pain that is beyond the control of painkillers, or if the pain is confined to a small area.

Depending on the situation, the radiation to the bone can be given over many days with a single high dose or multiple small doses. The side effects of radiation depend on the area being treated and its size.

Surgery

Surgical procedures help stabilize bones at risk of fractures and repair broken bones.

1. Bone Stabilizing Surgery: If there is a risk of bone fracture due to bone metastases, the surgeon can stabilize the bone with metal plates, screws and nails (orthopedic fixation). Orthopedic fixation can reduce pain and improve function [4]. Radiation therapy is often given when healed after surgery.

2. Surgery to inject cement into bone: Bone that cannot be easily reinforced with metal plates or screws, such as pelvic bone or spinal bone, can benefit from bone cement. Doctors inject bone cement into bone that has been destroyed or damaged by bone metastases. This procedure can relieve pain.

3. Surgery to repair a fractured bone: If a bone metastasis causes a fracture, the surgeon can work to repair the bone. Metal plates, screws and nails are used to stabilize bones. Joint replacements, such as hip replacements, may be another option. In general, putting a cast on a fractured bone does not help the fracture caused by the bone metastasis.

Heating and freezing cancer cells

Procedures that use heat or cold to kill cancer cells can help control pain. These steps may be an option if there are one or two areas of bone metastases and other treatments do not help. In a procedure called radiofrequency ablation, a needle with an electric probe is inserted into a bone tumor. An electric current flows through the probe and heats the surrounding tissue. Allow the tissue to cool and repeat this process. Tumors are frozen and then thawed using a similar procedure called cryoablation [5]. This process is repeated several times. Side effects may include damage to nearby structures such as nerves and bone damage that may increase the risk of fractures.

1. Sambi M, Qorri B, Harless W (2013) Breast Cancer Metastasis and Drug Resistance, Springer.

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2. Brook N, Brook E, Dharmarajan A, Dass CR, Chan A (2018) . Int J Biochem Cell Biol 96, 63–78.

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3. Soeharno H, Povegliano L, Choong PF (2018) Front Endocrinol 9:518.

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4. Errani C, Mavrogenis AF, Cevolani L, Spinelli S, Piccioli A, et al. (2017) Treatment for long bone metastases based on a systematic literature review. Eur J Orthop Surg Traumatol 27, 205–211.

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