The Effectiveness of Bisphosphonate to Reduce Pain in Lung Cancer Patients with Bone Metastasis


  • Noni Novisari Soeroso Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara Hospital, Medan, Indonesia
  • Freddy Panggabean Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara Hospital, Medan, Indonesia
  • Setia Putra Tarigan Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara Hospital, Medan, Indonesia
  • Fotarisman Zaluchu Department of Epidemiology, Universitas Sumatera Utara, Medan, Indonesia
  • Fannie Rizki Ananda Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara Hospital, Medan, Indonesia



Bisphosphonate, Bone metastasis, Non-small cell lung cancer, Cancer pain, Visual analog scale


Background: Bisphosphonates (BPs) are commonly used as supportive therapy to prevent skeletal-related events in lung cancer patients with bone metastasis, including severe bone pain, hypercalcemia, and pathological fractures. The purpose of this study was to assess the effectiveness of bisphosphonate therapy to reduce pain in non-small cell lung cancer (NSCLC) patients with bone metastasis. 

Methods: This was a cross-sectional study carried on 38 patients diagnosed with lung cancer based on cytology or histopathology findings. Radiological examination such as thoracic CT scan, bone survey, and bone scan was performed to determine bone metastasis. Multimodality therapy is carried out for lung cancer palliative therapy including chemotherapy, radiotherapy, and bisphosphonate therapy (zoledronic acid and ibandronate) as supportive therapy to reducing cancer pain. Pain was assessed using the Visual Analog Scale (VAS) determined by patients themselves. Statistical tests were performed by paired T-test in which p< 0.05 was considered significant. 

Results: As many as 38 patients enrolled in this study consisting of 29 men (76.3%) and 9 women (23.7%). The subtype of adenocarcinoma was mostly found in 31 cases (81.58%) and 7 cases (18.42%) was Squamous Cell Carcinoma. Cancer pain was found in all patients. Measurement of pain prior to treatment showed that most patients had VAS level of 7-10. After bisphosphonate therapy, the VAS level significantly decreased to 1-3 (p<0.01). 

Conclusion: Bisphosphonate therapy was proven to effectively decrease the severity level of cancer pain in lung cancer patients with bone metastasis.


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Arneson TJ, Li S, Peng Y, Weinhandl ED, Blaes A, Cetin K, et al. Estimated number of prevalent cases of metastatic bone disease in the US adult population. Clin Epidemiol 2012;4:87-93. PMid:22570568 DOI:

Wade RK, Hernandez RK, Adhia A, O’Connor E, Arellano J, Francis K, et al. Prevalence of bone metastases and bone-targeting agent use among solid tumor patients in the United States. Clin Epidemiol. 2015;7:335. PMid:26229504 DOI:

Bottiglieri S, Adams V, Smith KM. Pharmacologic prevention of skeletal-related events in cancer patients. Orthopedics. 2010;33(8):577-80. DOI:

Li EC, Davis LE. Zoledronic acid: A new parenteral bisphosphonate. Clin Ther. 2003;25(11):2669-708. DOI:

Saad F, Lipton A. Clinical benefits and considerations of bisphosphonate treatment in metastatic bone disease. Semin Oncol. 2007;34(6 Suppl 4):S17-23. PMid:18068486 DOI:

Hirsh V, Major PP, Lipton A, Cook RJ, Langer CJ, Smith MR, et al. Zoledronic acid and survival in patients with metastatic bone disease from lung cancer and elevated markers of osteoclast activity. J Thorac Oncol. 2008;3(3):228-36. PMid:18317064 DOI:

Hitron A, Adams V. The pharmacological management of skeletal-related events from metastatic tumors. Orthopedics. 2009;32(3):188. PMid:19309055 DOI:

Bonjour JP, Rizzoli R. Treatment of hypercalcaemia of malignancy with clodronate. Bone. 1991;12(Suppl 1):S19-23. PMid:1835397 DOI:

Bloomfield DJ. Should bisphosphonates be part of the standard therapy of patients with multiple myeloma or bone metastases from other cancers? An evidence-based review. J Clin Oncol. 1998;16(3):1218-25. DOI:

De Marinis F, Eberhardt W, Harper PG, Sureda BM, Nackaerts K, Soerensen JB, et al. Bisphosphonate use in patients with lung cancer and bone metastases: Recommendations of a European expert panel. J Thorac Oncol. 2009;4(10):1280-8. PMid:19701109 DOI:

Price N, Belani CP, Jain VK. Bisphosphonates to prevent skeletal morbidity in patients with lung cancer with bone metastases. Clin Lung Cancer. 2004;5(5):267-9. PMid:15086964 DOI:

Terpos E, Sezer O, Croucher PI, Garcia-Sanz R, Boccadoro M, San Miguel J, et al. The use of bisphosphonates in multiple myeloma: Recommendations of an expert panel on behalf of the European myeloma network. Ann Oncol. 2009;20(8):1303-17. PMid:19465418 DOI:

Jensen AØ, Jacobsen JB, Nørgaard M, Yong M, Fryzek JP, Sørensen HT. Incidence of bone metastases and skeletal-related events in breast cancer patients: A population-based cohort study in Denmark. BMC Cancer. 2011;11(1):29. PMid:21261987 DOI:

So A, Chin J, Fleshner N, Saad F. Management of skeletal-related events in patients with advanced prostate cancer and bone metastases: Incorporating new agents into clinical practice. Can Urol Assoc J. 2012;6(6):465-70. PMid:23282666 DOI:

Pain Assessment Scales; 1999. Available from: [Last accessed on 2019 May 12].

Papapetrou P. Bisphosphonate-associated adverse events. Hormones. 2009;8(2):96-110. PMid:19570737 DOI:

Soeroso NN, Zain-Hamid R, Sinaga B, Sadewa A, Syafiuddin T, Syahruddin E, et al. Genetic polymorphism of CYP2A6 and its relationship with nicotine metabolism in male bataknese smokers suffered from lung cancer in Indonesia. Open Access Maced J Med Sci. 2018;6(7):1199. PMid:30087722 DOI:

Soeroso NN, Zain-Hamid R, Sinaga BY, Sadewa AH, Syafiuddin T, Syahruddin E, et al. The role of CYP2A6 genetic polymorphism in nicotine dependence and tobacco consumption among bataknese male smokers the creative commons attribution-noncommercial 4.0 international license (CC BY-NC 4.0). J Med Sci. 2018;6(5):1857-9655. PMid:29875862 DOI:

Hess KR, Varadhachary GR, Taylor SH, Wei W, Raber MN, Lenzi R, et al. Metastatic patterns in adenocarcinoma. Cancer. 2006;106(7):1624-33. PMid:16518827 DOI:

Soeroso NN, Tarigan SP, Saragih W, Sari ND, Lubis N, Lubis H. Lung adenocarcinoma presenting with an orbital metastasis. Respir Med Case Rep. 2018;25:116-8. PMid:30112271 DOI:

Malik PS, Sharma MC, Mohanti BK, Shukla NK, Deo S, Mohan A, et al. Clinico-pathological profile of lung cancer at AIIMS: A changing paradigm in India. Asian Pac J Cancer Prev. 2013;14(1):489-94. PMid:23534779 DOI:

Brooks DR, Austin JH, Heelan RT, Ginsberg MS, Shin V, Olson SH, et al. Influence of type of cigarette on peripheral versus central lung cancer. Cancer Epidemiol Biomarkers Prev. 2005;14(3):576-81. PMid:15767332 DOI:

Stellman SD, Muscat JE, Thompson S, Hoffmann D, Wynder EL. Risk of squamous cell carcinoma and adenocarcinoma of the lung in relation to lifetime filter cigarette smoking. Cancer. 1997;80(3):382-8.<382:aid-cncr5>;2-u PMid:9241071 DOI:<382::AID-CNCR5>3.0.CO;2-U

Conen K, Hagmann R, Hess V, Zippelius A, Rothschild SI. Incidence and predictors of bone metastases (BM) and skeletal-related events (SREs) in small cell lung cancer (SCLC): A swiss patient cohort. J Cancer. 2016;7(14):2110-6. PMid:27877227 DOI:

Katakami N, Kunikane H, Takeda K, Takayama K, Sawa T, Saito H, et al. Prospective study on the incidence of bone metastasis (BM) and skeletal-related events (SREs) in patients (pts) with stage IIIB and IV lung cancer CSP-HOR 13. J Thorac Oncol. 2014;9(2):231-8. PMid:24419421 DOI:

Coleman RE. Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res. 2006;12(20):6243s-9. PMid:17062708 DOI:

Coleman RE. Skeletal complications of malignancy. Cancer. 1997;80(S8):1588-94.<1588:aid-cncr9>;2-z PMid:9362426 DOI:<1588::AID-CNCR9>3.0.CO;2-G

Cetin K, Christiansen CF, Jacobsen JB, Nørgaard M, Sørensen HT. Bone metastasis, skeletal-related events, and mortality in lung cancer patients: A Danish population-based cohort study. Lung Cancer. 2014;86(2):247-54. PMid:25240518 DOI:

Liu J, Huang W, Zhou R, Jia S, Tang W, Luo Y, et al. Bisphosphonates in the treatment of patients with metastatic breast, lung, and prostate cancer. Medicine (Baltimore). 2015;94(46):e2014. PMid:26579808 DOI:




How to Cite

Soeroso NN, Panggabean F, Tarigan SP, Zaluchu F, Ananda FR. The Effectiveness of Bisphosphonate to Reduce Pain in Lung Cancer Patients with Bone Metastasis. Open Access Maced J Med Sci [Internet]. 2022 Mar. 27 [cited 2024 Feb. 23];10(T7):185-9. Available from:

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