No Bone Drug Better Than Another

Multiple myeloma fractures and pain decreased with bisphosphonates

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Multiple myeloma is a cancer of the blood cells. It grows in the bone marrow, and can cause long bones like the thigh bone (femur) and bones in the spine to break. Drug therapy with a class of drugs can help to prevent these fractures.

A review published in The Cochrane Library finds that bisphosphonate drugs can reduce bone pain and fractures in people living with multiple myeloma. No specific brand in this class was found to be superior to another.

"Ask your doctor about bisphosphonates for bone health."

Bisphosphonate drugs work by blocking bone cells called osteoclasts that are involved in fractures. These drugs are marketed under a number of brand names, including: Actonel, Boniva, Fosamax and Reclast.

Investigators examined and analyzed data from 20 trials which involved nearly 6,700 patients who took bisphosphonate drugs along with other cancer treatments. 

The bisphosphonates did reduce the incidence of fractures and bone pain. Researchers found that between 6 and 15 people would need to be treated to prevent fractures in one individual; for pain to be reduced in one person, between 5 and 13 patients need to be treated.

In four of the trials, direct comparisons were made between the different drugs in the class. The other trials compared the drug effectiveness compared to a placebo.

Direct head-to-head and indirect comparisons didn't result in a clearly superior drug.

The review also found that serious adverse side effects appear to be rare. Among them is osteonecrosis of the jaw, where the bone can appear through wounds in the gum that don't heal.

"We didn't identify any significant adverse effects, but this work does highlight the need for larger head-to-head trials, which are needed to better compare the safety and effectiveness of the different drugs available," said lead researcher Ambuj Kumar, MD, MPH, of the Center for Evidence Based Medicine and Health Outcomes Research at the University of South Florida

This review was published May 15, 2012 in the Cochrane Database of Systematic Reviews 2012.

The study was supported by the Center for Evidence-based Medicine at The University of South Florida, Department of Internal Medicine at the University of Bonn, Germany, Leukämie-Initiative Bonn e.v., Germany and Cochrane Haematological Malignancies Group, Germany.

The authors declared no conflicts of interest.

Reviewed by: 
Review Date: 
May 15, 2012
Last Updated:
August 13, 2012