The role of the oncologist

Several oncological and hematological malignancies may present with bone disease. Clinical manifestations of bone disease are mainly osteolytic and /or osteoblastic skeletal lesions. Preclinical models both in vivo and in vitro have been developed to study tumor cell biology within bone microenvironment and have allowed investigators to better understand pathogenesis of neoplastic bone disease. These studies represented the basis to design targeted drugs that were able to restore normal bone microenvironment and turnover. Among these drugs, bisphosphonates (BPs) are the current mainstay of bone disease treatment. Indeed, BPs have been shown to be very efficient drugs, and are able to revert neoplastic bone turnover. However, BPs may have important toxicity and among the main side effects, we recognize osteonecrosis of the jaw. Because of these sequelae, international oncology societies and networks have suggested clinical guidelines to allow clinical oncologists to use these drugs in order to obtain the best results with least toxicities. Furthermore, prevention and treatment strategies of BP side effects can be best achieved through close interaction with other related clinical practitioners such as the dentist and maxillofacial surgeon.