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Systemic therapy
Bone-modifying therapy
Protecting bone that cancer or its treatment has weakened.
What it is
Bisphosphonates and denosumab reduce the bone breakdown driven by disease in the bone, and the bone loss driven by hormone therapy. They are given as an infusion or an injection at set intervals.
They are among the most under-used supportive treatments in Indian practice, and among the easiest to give, which makes forgetting them a genuine and avoidable harm.
When it is used
- Where cancer has spread to bone
- During hormone therapy that accelerates bone loss
- Where bone density is already low and treatment will worsen it
- For calcium control in defined situations
How the decision is made
- Dental clearance before starting. Osteonecrosis of the jaw is a recognised risk and a pre-treatment dental assessment substantially reduces it.
- Kidney function, which limits which agent and what dose.
- Calcium and vitamin D replacement alongside, which is not optional.
Infusion or subcutaneous injection at a partner day-care unit, at a set interval.
Who does what
What we handle, and what happens elsewhere
KPCIRC handles
- Bone-risk assessment and the decision to start
- Mandatory dental clearance before the first dose
- Calcium, vitamin D and renal monitoring schedule
- Bone density surveillance
- Coordination with the dental clinic for any future extraction
Performed and billed elsewhere
- The infusion or injection
- The medicine
- Bone density scanning
- Once you are on a bone-modifying agent, never have a tooth extracted without telling the dentist. Say it every time, the jaw risk persists long after the last dose.
Questions to ask your own doctor
Take these with you. They work whether or not you are treated here.
- Do I need dental clearance first, and how long will that take?
- How often, and for how long?
- What calcium and vitamin D should I be taking?
- What do I tell a dentist in future?
Support that goes with it
Where this is used
Cancers this commonly forms part of
Not sure this is the right option for you?
That is exactly what a second opinion is for. Bring what you have, we will tell you what is missing and what the alternatives actually are, in writing.