Bone lesions in malignant diseases--II. Therapeutic management.

A pathogenetically based therapeutic strategy and modality for malignant bone diseases has been created only in the last two decades. The most frequent pathogenetic defect, osteoblast/osteoclast uncoupling in the osteolytic foci and the diffuse humoral osteoporosis afford little in terms of choice of treatment which makes the inhibitors of osteoclastic activity the major medicamentous agents for their management. We discuss the mechanisms of action, pharmacokinetics, preparations and regimens of administration of biphosphonates, calcitonine and galium nitrate. Results of large double blind, placebo-controlled studies of clondronate and pamidronate in oncohematologic diseases are summarised: statistically significantly lower frequency of the osteolytic foci, pathological fractures, hypercalcemic episodes, low levels of C-L bonds, increase of bone mineral density, management of pain, and better quality of life.