Efficacy of Bone Modifying Agents
In the absence of reliable evidence, it is the opinion of the workgroup that the use of BMAs may assist in reducing incidence of femur fractures in patients with bone lesions from metastatic carcinoma or multiple myeloma.


We did not identify any literature with the purpose of determining the efficacy of BMAs in reducing femur fractures or other skeletal related events specifically among patients with metastatic carcinoma or myeloma lesions involving the femur. However, there are studies among patients with metastatic carcinoma or myeloma bone lesions not explicitly localized to the femur (Fizazi, 2009; Hortobagyi, 2017; Raje 2016/18; Lipton 2000/12; Morgan 2011/13; Stopeck, 2010, Martin 2012) demonstrating reduction in skeletal related events with use of BMAs.

Due to the observed benefit in these studies of improved clinical outcomes in context of the acceptable safety profile of commonly used BMAs, it is our consensus that treatment with BMAs in patients with metastatic carcinoma or myeloma involving the femur is advised.

Future Research

Future research should specifically assess outcomes of femur fractures in patients with metastatic carcinoma or myeloma treated with BMAs.


The Future of OrthoGuidelines


The OrthoGuidelines Process