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Bisfosfonatos _ Sociedad Canadiense del Cáncer.pdf
1. 17/2/22, 12:02 Bisfosfonatos | Sociedad Canadiense del Cáncer
https://cancer.ca/en/treatments/treatment-types/bisphosphonates 1/9
Los bisfosfonatos son un grupo de medicamentos que se pueden usar para ayudar a
proteger los huesos contra los efectos de algunos tipos de cáncer y para tratar algunas
afecciones óseas. A veces, los bisfosfonatos se denominan tratamientos de
fortalecimiento óseo o endurecimiento óseo.
Los bisfosfonatos se pueden usar para tratar el mieloma múltiple y las metástasis
óseas.
Cómo funcionan los bisfosfonatos
Los bisfosfonatos ralentizan la acción de las células óseas (osteoclastos) que disuelven
pequeños fragmentos de huesos para ayudar a remodelarlos y mantenerlos fuertes.
Cuando el cáncer se disemina al hueso (hace metástasis), estas células se vuelven
hiperactivas, lo que hace que el hueso se destruya más rápido de lo que se
reconstruye. Cuando esto sucede, el daño puede hacer que los huesos se vuelvan más
delgados y débiles, lo que provoca:
dolor en los huesos afectados
niveles altos de calcio en la sangre ( hipercalcemia )
un mayor riesgo de rotura de huesos (fractura)
Tipos de tratamiento
Bisfosfonatos
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Usos de los bisfosfonatos
Los bisfosfonatos ralentizan la descomposición de los huesos. Se pueden usar para:
reducir el dolor óseo causado por metástasis óseas o mieloma múltiple
reducir los niveles altos de calcio en la sangre
ayudar a fortalecer los huesos y reducir el riesgo de fracturas causadas por
cáncer, metástasis óseas u osteoporosis
Dolor de huesos
La mayoría de los cánceres que afectan los huesos comenzaron en otra parte del
cuerpo y se diseminaron al hueso. Los tipos más comunes son el cáncer de mama, el
cáncer de próstata y el cáncer de pulmón. El dolor del cáncer a menudo está
relacionado con metástasis óseas.
El mieloma múltiple es un cáncer de células plasmáticas anormales (un tipo de
glóbulos blancos) que se acumulan en la médula ósea. Estas células anormales
producen una sustancia que provoca daño óseo y dolor óseo.
hipercalcemia
Cuando las metástasis óseas y el mieloma múltiple hacen que los huesos se rompan, el
calcio sale de los huesos y pasa al torrente sanguíneo. Esto puede hacer que aumenten
los niveles de calcio en la sangre. Un alto nivel de calcio en la sangre se llama
hipercalcemia. Esto también puede hacer que los huesos se debiliten y se vuelvan
frágiles y se rompan con facilidad.
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Osteoporosis
La pérdida de masa ósea (o densidad ósea) se denomina osteoporosis. Esta condición
hace que el hueso se debilite y sea más probable que se rompa. Algunos tratamientos
contra el cáncer, como los tratamientos a largo plazocorticosteroide usar,terapias
hormonales y algunos medicamentos de quimioterapia pueden aumentar el riesgo de
osteoporosis. La osteoporosis también puede ocurrir debido a factores no
relacionados con el cáncer. Los bisfosfonatos se pueden usar para prevenir y tratar la
osteoporosis.
Tipos de bisfosfonatos
The type of bisphosphonate used can depend on the type of cancer being treated.
Common bisphosphonates used to treat bone metastases and multiple myeloma
include:
clodronate (Bonefos) given by mouth or by an intravenous (IV) infusion (through
a vein)
pamidronate (Aredia) given by an IV infusion
zoledronic acid (Zometa) given by an IV infusion
Bisphosphonates used to prevent and treat osteoporosis include alendronate
(Fosamax), risedronate (Actonel) and etidronate (Didrocal, Didronel).
Taking bisphosphonates
Bisphosphonates can be taken as pills or by an IV infusion.
Pills are usually taken once or twice per day on an empty stomach.
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IV infusions are usually given every 3 to 4 weeks. They can take anywhere from 15
minutes to 4 hours, depending on which bisphosphonate is given. They can be given at
the hospital or at home by a homecare nurse.
Follow-up after bisphosphonates
Follow-up when bisphosphonates are given includes:
checking to see if bone pain has lessened
blood chemistry tests to check how the kidney is working and calcium level
a bone density scan
Side effects
Side effects can happen with any type of treatment, but everyone’s experience is
different. Some people have many side effects. Other people have few or none at all.
If you develop side effects, they can happen any time during, immediately after or a
few days or weeks after bisphosphonate therapy. Most side effects go away on their
own or can be treated, but some side effects may last a long time or become
permanent.
Side effects of bisphosphonate therapy will depend mainly on the type of
bisphosphonate, the dose, how the drug is given and your overall health. Tell your
healthcare team if you have these side effects or others you think might be from
bisphosphonates. The sooner you tell them of any problems, the sooner they can
suggest ways to help you deal with them.
The following are some side effects of bisphosphonate therapy.
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Fatigue
Fatigue is a general lack of energy and tiredness that can happen during
bisphosphonate therapy. Fatigue makes a person feel more tired than usual and can
interfere with daily activities and sleep. It tends to be worse when you are also having
other treatments, such as chemotherapy or radiation therapy.
Increased bone pain
Sometimes bone pain can temporarily become worse when you first take
bisphosphonates. This side effect is often temporary. You may be given stronger pain
relievers until this side effect goes away.
Digestive problems
Digestive problems can happen, especially when the bisphosphonate is taken as pills.
Digestive problems include:
nausea and vomiting
heartburn
abdominal cramps or pain
diarrhea
Flu-like symptoms
Flu-like symptoms can happen shortly after bisphosphonates are given. They include
fever, chills, muscle and joint aches or pain and headaches. These side effects do not
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usually happen and are often temporary. They are more likely to happen after
bisphosphonates are given by an IV infusion.
Low calcium levels
Bisphosphonates can lower blood calcium to below normal levels. This side effect
does not usually happen and is often temporary. Calcium levels in the blood are often
checked when you are given bisphosphonates.
Change in how the kidney works
Bisphosphonates can affect how the kidney works. It does not often cause any
symptoms. Blood tests to check the kidney are done while you are taking
bisphosphonates.
Osteonecrosis
Osteonecrosis is the death of bone caused by poor blood supply to the area.
Osteonecrosis of the jaw bone underneath the teeth is a rare side effect of some
bisphosphonates if they are taken for over a year. It is sometimes seen when a tooth is
pulled in someone who is taking bisphosphonates. Osteonecrosis is not usually seen in
people who take bisphosphonates as pills.
Osteonecrosis can cause loosening of the teeth and tooth loss and infection or open
sores of the jaw bone that don’t heal. These sores are often hard to treat.
You may be advised by your doctor to get a dental check-up and have tooth or jaw
problems treated before starting to take bisphosphonates. Maintaining good oral
hygiene, making sure your dentures are well fitted and having regular dental check-
ups might help prevent osteonecrosis of the jaw.
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Information about specific cancer drugs
Details on specific drugs change regularly. Find out more about sources of drug
information and where to get details on specific drugs.
Expert review and references
References
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