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Evidence summaries

Bisphosphonates for the Relief of Pain Secondary to Bone Metastases

Bisphosphonates appear to have at most a weak analgesic effect in bone metastases. Level of evidence: "B"

The quality of evidence is downgraded by inconsistency.

Summary

A Cochrane review [Abstract] 1 included 30 studies with a total of 3 682 subjects. For the proportion of patients with pain relief (eight studies) pooled data showed benefits for the treatment group, with an NNT at 4 weeks of 11 (95% CI 6 to 36) and at 12 weeks of 7 (95% CI 5 to 12). In terms of adverse drug reactions, the NNH was 16 (95% CI 12 to 27) for discontinuation of therapy. Nausea and vomiting were reported in 24 studies with a non-significant trend for greater risk in the treatment group. One study showed a small improvement in quality of life for the treatment group at 4 weeks.

Another systematic review 2 included 43 studies (8 595 subjects in bisphosphonate and 7 590 subjects in denosumab trials). This review updated the 2002 Cochrane review. Twenty-two (79%) of the 28 placebo-controlled studies found no analgesic benefit for bisphosphonates, and none of the denosumab studies assessed direct pain relief.The review concluded that evidence to support an analgesic role for bisphosphonates and denosumab is weak, and they appear to be beneficial in preventing pain by delaying the onset of bone pain rather than by producing an analgesic effect per se.

    References

    • Wong R, Wiffen PJ. Bisphosphonates for the relief of pain secondary to bone metastases. Cochrane Database Syst Rev 2002;(2):CD002068. [PubMed]
    • Porta-Sales J, Garzón-Rodríguez C, Llorens-Torromé S, et al. Evidence on the analgesic role of bisphosphonates and denosumab in the treatment of pain due to bone metastases: A systematic review within the European Association for Palliative Care guidelines project. Palliat Med 2017;31(1)5-25. [PubMed]

Primary/Secondary Keywords