Bone Metastases: Targeted Treatments & Bone Health

This page is for people whose breast cancer has spread to the bone, and their families. It covers how bone metastases are found, the drugs that protect bone, pain relief, and warning signs that need urgent care.

Breast cancer is one of the cancers that often spreads to bone. The American Cancer Society (ACS) says the bones are a common place for cancer to spread, and that bone metastases can be found at the same time as the first cancer or months or even years later.

Hearing "it's in your bones" can be frightening. Treatment depends on the type of primary cancer, where it has spread, past treatments and your general health. Ask your team what the outlook looks like for your situation.

Hearing "it's in your bones" is frightening. NCI says some people can live for years with metastatic cancer that is well controlled. That is not a promise about any one person, so it is worth asking your team what it means for you.

Imaging after treatment can be confusing. If a scan report worries you, ask directly whether the change reflects progression or healing.

If a scan report worries you, ask directly what the change means and what happens next.

ACS lists the medicines most often used for bone problems in people with bone metastases: the bisphosphonates pamidronate (Aredia) and zoledronic acid (Zometa), and the bone-targeted drug denosumab (Xgeva). They are given into a vein or under the skin. ACS says they can help prevent further bone damage and problems caused by weakened bones, such as fractures, high blood calcium and spinal cord compression.

They do not treat the cancer itself. Your cancer treatment does that. It is common to be on both.

The dosing interval. How often you get treatment varies. Which agent you get, at what interval, and whether you get one at all depends on:

Dental care. ACS says osteonecrosis of the jaw, in which part of the jawbone has died, is a rare but serious side effect. It says doctors will probably recommend a dental checkup before starting treatment so that any dental problems can be taken care of first. The Xgeva label says patients should tell their dentist they are receiving it, and should avoid invasive dental procedures during treatment.

Dental care. Osteonecrosis of the jaw (a condition where part of the jawbone dies) is serious. MedlinePlus advises finishing dental exams and treatments before starting denosumab. Tell any dentist you are on these drugs.

Your doctor may advise calcium and vitamin D supplements with denosumab. Denosumab can cause serious low calcium levels, with numbness, tingling or muscle stiffness. Tell your team right away if you notice these.

ACS says bone pain can be treated in several ways: treating the cancer, medicines made to stop the effects of the cancer on the bone, local treatments such as radiation therapy or surgery for a small area of metastases that is causing pain, and pain medicines.

Bone pain can often be treated. NCI notes that radiopharmaceuticals can treat pain from cancer that has spread to bone. Ask your team whether radiation or other options could help your pain. Do not put up with pain without telling them.

Pain control generally combines radiation, systemic therapy, and analgesics (pain medicines). A palliative care team is often the group with the most expertise here. NCI says palliative care started soon after an advanced cancer diagnosis can improve quality of life and mood.

These situations are urgent rather than routine.

Spinal cord compression. ACS says cancer in the spine can press on the spinal cord, that it is an oncology emergency, and that without treatment right away the person can become paralyzed. It lists these signs:

• back or neck pain, sometimes with pain going down one or both legs (one of the first symptoms)
• numbness of the legs or belly
• leg weakness or trouble moving your legs
• loss of control of urine or stool, or problems passing urine

Spinal cord compression is an emergency. Do not wait for more symptoms to develop. Contact your oncology team immediately, including at nights and weekends. If you cannot reach anyone quickly, go to an emergency department and say you have breast cancer in the bones and may have spinal cord compression.

Broken or weakened bone. ACS says a weak bone can break during normal activities, and that breaks often cause sudden, severe pain, most often in the long bones of the arms and legs and the spine. Sudden severe pain needs a call to your care team right away. If you cannot reach them, go to an emergency department.

High calcium. MedlinePlus lists nausea or vomiting, poor appetite, constipation, increased thirst or more frequent urination, muscle weakness, and tiredness or confusion as symptoms of a high calcium level. Call your care team the same day if these appear. Go to an emergency department or call 911 if confusion or drowsiness is worsening.

• Is my disease bone-only, or is it also elsewhere?
• Am I on a bone-modifying drug? Which one, and how often?
• Have I had a dental check?
• Which bones are at fracture risk, and do any activity limits apply?
• Who do I call after hours, and what exactly should prompt that call?

• MedlinePlus: Denosumab injection
• ACS: Bone Metastases
• NCI: Denosumab
• NCI: Metastatic cancer
• NCI: Palliative care in cancer fact sheet
• DailyMed: XGEVA (denosumab) prescribing information
• MedlinePlus: Hypercalcemia