Strengthening painful bones

Cancer that spreads to the bones often causes pain. Also, cancer in the bones can make them weak and more likely to break. This type of break is called a pathological fracture. This can be more of a problem in cancers such as breast cancer, prostate cancer and myeloma.

Doctors can treat weakened bones affected by cancer by using either medicines or surgery. Your doctor will know which of these treatments may be best for you in your situation.

Bone strengthening medicines

Cancer that has spread to the bone can cause weakness, which can cause pain. This can be a problem in advanced cancer, especially with breast cancer, prostate cancer and myeloma.

Bone strengthening drugs are used to help:

• control bone pain so you need a smaller amount of painkillers

• slow down or prevent damage caused by cancer spread to the bones

These medicines include:

• a group of drugs called bisphosphonates

• Denosumab

Bisphosphonates are drugs that target areas of higher bone turnover. Denosumab is a type of targeted therapy.

You can ask your healthcare team whether this is a suitable treatment for your cancer type and situation. Depending on the drug, you might have this treatment as:

• an infusion into your bloodstream (intravenous)

• an injection just under the skin (subcutaneous)

• a capsule or tablet

Bone strengthening surgery

Doctors can treat bones affected by cancer by using special cement to strengthen them. This is called cementoplasty. There are two techniques:

• percutaneous cementoplasty

• vertebroplasty and kyphoplasty

Percutaneous cementoplasty

Cementoplasty means using a special cement to strengthen and support bone. Percutaneous means under the skin, and describes how the cement is put into the bone.

Doctors use the cement to fill parts of bone destroyed by cancer that are causing pain. It can help to relieve pain and make the bone more stable. It has also improved walking for some people.

You have this minor operation either under a general anaesthetic . Or you can have it when you are drowsy, after taking a sedative . Using x-rays to guide the way, the doctor puts a needle into the skin and injects the cement into the bone.

You are most likely to have percutaneous cementoplasty to help control symptoms of secondary bone cancer. Secondary bone cancer is when a cancer that’s started somewhere else in the body has spread to the bones. You are less likely to have this treatment for a cancer that started in the bone (primary bone cancer).

The National Institute for Health and Care Excellence (NICE) guidance says that doctors can use percutaneous cementoplasty as part of NHS treatment, but only if other ways of treating your pain have not worked.

Vertebroplasty and kyphoplasty

These are different forms of cementoplasty for the spine.

Vertebroplasty

In vertebroplasty, bone cement is injected into damaged bones in the spine (vertebrae). The treatment eases pain and helps to support the spine.

Some studies have shown that vertebroplasty can relieve pain in up to 8 out of 10 people (up to 80%) with myeloma or other types of cancer that have spread (metastatic cancers).

Kyphoplasty

Balloon kyphoplasty is similar to vertebroplasty. It treats fractures of the spine. For kyphoplasty, little balloons are put into the spine. They are slowly inflated so that the spine goes back to as near its normal height as possible. Then special cement is injected into the space created by the balloon to strengthen the bone.

Clinical trials have shown that this technique can help to relieve pain and restore some height.

Access to treatment

NICE has issued guidance on vertebroplasty for treating fractures in people with painful conditions of the spine, including tumours. They say that doctors should consider it only if other ways of treating your pain have not worked.

NICE has approved balloon kyphoplasty for use in the NHS as a treatment for collapsed bones in the spine.