Secondary prevention

Patients should undergo pneumonia and flu vaccination. Good hydration should be maintained to avoid renal complications.[175]​ Use of non-steroidal anti-inflammatory drugs should be minimised, contrast dyes avoided with radiological examinations, and infections treated promptly.

Bisphosphonates (e.g., zoledronic acid, pamidronate) can be used to prevent bone-related complications, including pathological fracture.[176][177] [ Cochrane Clinical Answers logo ] Denosumab (a monoclonal antibody that targets the receptor activator of nuclear factor-kappaB ligand [RANKL]) may be used instead of bisphosphonates, particularly for patients with renal impairment.[176][177][178] In June 2018, the UK Medicines and Healthcare products Regulatory Agency issued a safety alert following a pooled analysis of four phase 3 studies of denosumab in patients with advanced malignancies involving bone.[179] New primary malignancies were reported more frequently among patients receiving denosumab than those receiving zoledronic acid (cumulative incidence of new primary malignancy at 1 year was 1.1% for denosumab and 0.6% for zoledronic acid). No treatment-related pattern for individual cancers or cancer groupings was identified.

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