Clodronate in the management of breast cancer and multiple myeloma.

The rationale for the use of the bisphosphonates in tumour-induced osteolysis is well established. The evidence to date supports the view that bone destruction continues despite of sysytemic therapies directed against the tumour so that supplementary bone protection should be considered. Long-term treatment with clodronate or pamidronate has been shown to modify the progression of skeletal disease. The efficacies or oral and intravenous bisphosphonates seem similar and the numbers-needed-to-treat compare very favourably with the use of treatments as secondary prevention in other diseases. Further research is required to determine if we can better identify sub-groups of patients who will derive particular benefit, or perhaps not benefit at all, from bisphosphonate therapy. The use of biochemical markers of bone resorption and formation to evaluate the risk of skeletal disease and its response to treatment also requires further study.