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    Bisphosphonates continued...

    Possible side effects. The most common ones include:

    A rare and serious side effect is bone death ( osteonecrosis) of the jaw. Ask your doctor about precautions to take before beginning this treatment. Osteonecrosis may cause:

    • Jaw bone pain, swelling, or numbness
    • Loss of gum tissue
    • Loose teeth
    • Infection

    Another available treatment is denosumab (Xgeva). It's given by injection and may work as well as or better than bisphosphonates to prevent fractures. But it also can cause osteonecrosis, as well as low calcium levels in the blood.


    These drugs contain radioactive elements that target cancer cells. Doctors tend to use this systemic treatment when the metastasis is stimulating new bone growth. This is more common with prostate cancer.

    If your cancer has spread to many bones, these drugs may be a better option than standard radiation, which uses a beam to aim radiation at each bone metastasis. However, sometimes doctors combine radiopharmaceuticals and standard radiation.

    How it works. The doctor injects a single dose of the drug into a vein. It then travels to the areas of bone with cancer and gives off radiation to kill the cancer. This single dose may be effective against pain for several months. You can receive another treatment later.

    Possible side effects. The most common ones include:

    • Infections
    • Bleeding
    • Temporary increase in pain (flare reaction)


    This systemic treatment helps your immune system spot and more effectively kill cancer cells. Some methods of immunotherapy have been used for a while, and some are still experimental.

    How it works. Immunotherapy works in one of two main ways:

    • It boosts your body's immune system to fight the cancer.
    • It uses a man-made version of proteins to kill cancer cells.

    Examples of immunotherapy for cancer include:

    • Cytokines -- substances secreted by the immune system that have an effect on other cells
    • Monoclonal antibodies -- a class of antibodies made in the lab from a single population of cells
    • Tumor vaccines -- vaccines using a substance that prompts the immune system to respond to a tumor

    Possible side effects. Side effects vary, depending upon the type of immunotherapy. They may include:

    How Cancer Spreads to Bones

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