Usually, the first step in treating bone complications is to get any bone pain that exists under control. Over-the-counter medications include acetaminophen (Tylenol, others) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, naproxen (Aleve, others) and ibuprofen (Advil, others). Prescription medications include opioids such as oxycodone, hydromorphone and morphine. The right pain medication, dose and schedule can relieve pain without causing further problems.

It’s important that you tell your doctor immediately if you have severe back pain, or back pain that develops or changes rapidly. This may mean that a bone metastasis is pressing against your spinal cord. If that is the case, urgent medical care is required. Treatment options for this condition include steroids, radiation and surgery.

Medications

Your doctor may prescribe medications to improve the health of your bones and to reduce the risk of fractures.

RANK ligand inhibitors. Denosumab (Xgeva, Prolia) is designed to block a factor in bone development known as RANK ligand, which stimulates cells that break bone down. By blocking RANK ligand, denosumab may increase bone density and strength and help prevent the cancer from penetrating into the bone.

Bisphosphonates. These medications belong to a class of drugs called osteoclast inhibitors. They bind to the bone surface and slow the action of osteoclasts (a cell that breaks down bone). Bisphosphonates include alendronate (Fosamax), ibandronate (Boniva, Bondronat), pamidronate (Aredia), risedronate (Actonel, Atelvia) and zoledronic acid (Reclast, Zometa). By destroying osteoclasts, these medications help build bone, potentially resulting in an increase in bone density and helping to block cancer from penetrating into the bone.

SERMs. Another class of drugs used to prevent and treat bone complications is selective estrogen receptor modulators (SERMs). The exact way SERMs act to increase bone density is not fully known, but they are believed to slow the breakdown and removal of old bone. Drugs in this class include raloxifene (Evista), tamoxifen (Nolvadex, Soltamox) and toremifene (Fareston).