Progress in the Management of Bone Metastases: One Continent at a Time?

Bone metastases are a common extension of breast, prostate, and lung cancers, multiple myeloma, malignant lymphomas, and to a lesser extent, other solid tumors.1 In addition to pain, bone metastases frequently cause compli-cations such as pathologic fractures, hypercalcemia, and spinal cord compression.2 These complications have a ma-jor impact on quality of life, and their control requires multiple therapeutic interventions. Over the last 20 years, bisphosphonates became an integral part of the manage-ment of bone metastases. Bisphosphonates are pyrophos-phate analogs with potent antiresorptive activity, based on inhibition of osteoclast activity, recruitment, and differen-tiation.3 Multiple clinical trials have demonstrated that bisphosphonates represent the treatment of choice for hy-percalcemia of malignancy. Initially pamidronate, then