Bisphosphonates for breast cancer in men

Bisphosphonates are drugs that are used to help strengthen bones and, reduce the risk of fractures, and pain in bones that have been weakened by metastatic breast cancer. The most common bisphosphonates used in breast cancer patients are pamidronate (Aredia^®) and zoledronic acid (Zometa^®). They are given intravenously (IV).

Bisphosphonates may also help against bone thinning (osteoporosis) from treatment with aromatase inhibitors and LHRH analogs (see the “Hormone therapy for breast cancer in men” section). There are a number of medicines, including some oral forms of bisphosphonates, to treat loss of bone strength when it is not caused by cancer spread to the bones.

Bisphosphonates can have side effects, including flu-like symptoms and bone pain. They can also lead to kidney problems, so patients with poor kidney function may not be able to be treated with these drugs.

A rare but very distressing side effect of bisphosphonates is damage (osteonecrosis) in the jaw bones or ONJ. It can be triggered by having a tooth removed while getting treated with the bisphosphonate. ONJ often appears as an open sore in the jaw that won't heal. It can lead to loss of teeth or infections of the jaw bone.

Doctors don't know why this happens or the best way to treat it, other than to stop taking bisphosphonates. Maintaining good oral hygiene by flossing, brushing, making sure that dentures fit properly, and having regular dental checkups may help prevent this. Most cancer doctors recommend that patients have a dental checkup and have any tooth or jaw problems treated before they start taking a bisphosphonate.