How are bisphosphonates used today in breast cancer clinical practice?

In the United States there are approximately 100,000 women living with metastatic breast cancer. Bone is the most common site of breast cancer metastases and it is estimated that up to 85% of patients dying from this disease have developed osseous involvement. Skeletal metastases are often associated with dangerous and painful events such as fractures, spinal cord compression, and hypercalcemia. Bisphosphonates, through their inhibition of osteoclastic bone-resorptive activity, offer a rational approach to the management of bone metastases as they are of proven efficacy in reducing skeletal-related events. Bisphosphonates are also effective in the prevention and treatment of hypercalcemia and osteoporosis. The American Society of Clinical Oncology guidelines are instructive regarding patient selection for bisphosphonate therapy; however, a number of unanswered questions remain on how best to utilize this therapeutic intervention. This article reviews the role of bisphosphonates in the care of patients with breast cancer.