Case report: Use of a bisphosphonate (etidronate) to improve metastatic bone pain in three hospice patients

Objective: This report investigates the association among the bisphosphonate etidronate and relief of metastatic bone pain. Maintaining cognitive function while providing adequate relief from metastatic bone pain can be particularly difficult in elderly patients. Design: Case Series. Setting: Rural community dwellings (Carroll County, Maryland) and an urban nursing home (Baltimore, MD). Patients: One patient residing in a skilled nursing facility and two patients from a home hospice program (Carroll Hospice). Interventions: Administration of 400 mg of etidronate in cases of refractory metastatic bone pain. Main outcome measures: Reduction in analgesic dosing, improvement in cognitive function, and subjective pain improvement. Results: Three cases are presented in which the use of the bisphosphonate etidronate allowed for a reduction in opiate use with improvement in pain control and preservation of cognitive function. Conclusion: Etidronate and perhaps bisphosphonates, in general, should be considered in the management of refractory metastatic bone pain, particularly in the hospice population.