Adverse events associated with bone-directed therapies in patients with cancer

Bone metastatic disease may lead to serious adverse events in patients with cancer. Bone-directed therapies, including bisphosphonates such as pamidronate and zoledronic acid and the human monoclonal antibody denosumab, are currently approved for the prevention of bone-related adverse events. However, despite the benefits of these drugs, they may cause side effects that are mostly associated with dosages and treatment durations. These side effects range from more frequent, mostly mild, and generally self-limited side effects—such as fever, myalgias, arthralgias, and electrolyte imbalances—to less frequent and more severe side effects such as medication-related osteonecrosis of the jaw and atypical femoral fractures. The purpose of this review is to familiarize clinicians with the literature regarding adverse events associated with bone-directed therapies in patients with cancer. It is important to be aware of these possible adverse events and to educate patients about the predisposing factors associated with side effects from bone-directed therapies and the preventive measures necessary to decrease the risk of occurrence. •Bone metastatic disease may lead to serious adverse events in patients with cancer•Intravenous bisphosphonate therapy may lead to a transient acute-phase reactions•Bisphosphonate therapy may alter serum electrolytes and cause hypocalcemia and hypophosphatemia•Medication-related osteonecrosis of the jaw is a relatively uncommon but potentially serious side effect of bisphosphonates and denosumab.•Atypical femoral fracture is a rare and serious complication linked to long-term use of antiresorptive therapy