RT Journal
A1 Waterman, Gabriel N.
A1 Yellin, Ori
A1 Jamshidinia, Kamran
A1 Swift, Regina A.
A1 Tamkin, James A.
A1 Audell, Robert A.
A1 Berenson, James R.
T1 Metatarsal Stress Fractures in Patients with Multiple Myeloma Treated with Long-Term BisphosphonatesA Report of Six Cases
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2011
FD September 21
VO 93
IS 18
SP e106 1
OP 9
DO 10.2106/JBJS.J.00455
UL http://dx.doi.org/10.2106/JBJS.J.00455
AB 
The nitrogen-containing bisphosphonates (N-BPs), zoledronic acid and pamidronate, are potent inhibitors of bone loss6,7. When administered intravenously (IV) on an ongoing monthly basis, these drugs reduce the occurrence of skeletal complications in patients with multiple myeloma8-12, and monthly IV N-BP therapy is the current standard of care for these patients. N-BPs are also effective in the treatment of patients with metastatic bone disease and some benign disorders associated with increased bone loss13-15. Preclinical studies have demonstrated that N-BPs exert many antitumor effects16,17. Recent clinical studies have shown that these drugs, especially zoledronic acid, can improve the survival time of patients with cancer18,19. A recent large randomized trial from the Medical Research Council involving previously untreated patients with multiple myeloma demonstrated that monthly administration of zoledronic acid improved overall survival time compared with that of patients treated with daily oral clodronate, a weaker non-N-BP20. Since these results will likely lead to more prolonged zoledronic-acid treatment for multiple myeloma, complications of long-term N-BP therapy will become important to identify.