Table 2.

Common drugs and therapeutic techniques for the treatment of bone metastases.

Agent	Mechanism of Action	Side Effects
Bisphosponates (BPs)	Inhibition of bone demineralization by the interruption of enhanced osteolysis and tumor growth [16]	Fever, arthralgia, myalgia, anemia, nausea and peripheral edema. Osteonecrosis of the jaw (rare, difficult to establish casative evidence) [17]
Tetracyclines	Inhibition of matrix metalloproteinases (MMPs) involved in bone metastasis [17]	Dose-limiting toxicity e.g., fatigue and nausea, development of resistance [18] Generally well tolerated in adults
Denosumab	Inhibition of RANKL which prevents the development of osteoclasts	Similar to those exhibited by BPs, but reversible after treatment interruption [15]
Cabozantinib	Inhibition of vascular endothelial growth factor receptor-2 (VEGFR2), MET, KIT and mutationally activated RET [15]	Fatigue, diarrhea and palmar-plantar erythrodysesthesia syndrome [19]
Radionuclide therapy	Systemic administration of radioisotopes, but the mechanism of pain relief is uncertain [20]	Myelosuppression and pain flare [15]
Ablation	Use of chemical agents (ethanol, acetic acid) or local deposition of some form of energy (e.g., for radiofrequency and cryoablation) to destroy tumor cells [21]	Neurologic injuries, neuropathic pain and infection in the treatment area (especially for radiofrequency and cryoablation) [22]