For many solid tumors, bone is a common site of spread and one that compromises the quality of life of patients. The routine use of adjunctive intravenous bisphosphonates (IVBs) decreases skeletal related events such as fracture, hypercalcemia, spinal cord compression, and the need for palliative radiation therapy or orthopaedic stabilization. Denosumab has recently been approved as a bone modifying agent in oncology. This monoclonal antibody inhibits the receptor activator of nuclear factor kB ligand (RANKL), which mediates osteoclast differentiation, function and survival. In patient with bone metastases, Denosumab is at least equivalent to the IVBs. While the incidence of osteonecrosis of the jaw is similar to what has been reported with the IVBs, fever and pyrexia are not observed, and hypocalcemia and renal impairment are less frequent. We review the data leading to approval of denosumab as a bone-directed therapy in oncology and compare and contrast the efficacy and toxicity with intravenous bisphosphonates.
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