Bisphosphonate and Denosumab Therapy: Fields of Application

Bisphosphonates are highly effective in preserving bone mineral density and have a favorable benefi t-risk profi le. Thereby, bisphosphonates became the preferred antiresorptive drug for malignant and nonmalignant diseases characterized by various kinds of bone loss. In general, bisphosphonates may be considered as treatment option for preserving bone mineral density in any disease accompanied by increased bone resorption, regardless of the pathogenic mechanisms involved. Typical and frequent indications are postmenopausal osteoporosis, breast cancer, prostate cancer, and multiple myeloma. Bisphosphonates exert benefi cial effects beyond their antiresorptive properties and reduce morbidity and mortality in malignant and nonmalignant diseases. Especially, the antitumor activity described in several malignancies is intriguing. The molecular mechanisms generating these additional benefi cial effects are still incompletely understood. Among bisphosphonates, zoledronic acid is the most potent and most thoroughly studied substance. Of all bisphosphonates, zoledronate displays the most benefi cial effects in reducing fracture risk, antitumor activity, and additional effects but also the highest risk of adverse events, including BRONJ/MRONJ. Denosumab has a similarly high antiresorptive capacity as zoledronic acid. In certain settings, it may be a suitable alternative to bisphosphonate therapy. F. S. Oduncu , MD, PhD Department of Hematology and Oncology , Medizinische Klinik und Poliklinik IV, Klinikum der Universität München , Ziemssenstrasse 1 , Munich , Bavaria D-80336 , Germany e-mail: [email protected]