Bisphosphonates: ready for use as adjuvant therapy of breast cancer?

To describe recent data on the effects of bisphosphonates on bone health for patients with primary breast cancer.

Data are accumulating regarding the salutary effect of bisphosphonates on bone health. Preservation of bone mineral density, a surrogate for fracture risk, has been demonstrated in randomized controlled trials of bisphosphonates. These trials have included premenopausal and postmenopausal women and endocrine and chemotherapy adjuvant breast cancer treatments. In these trials there has been a focus on gonadal dysfunction, use of aromatase inhibitors and the risk of osteopenia/osteoporosis. Data with bisphosphonates in this clinical setting have not confirmed clinical benefit for fracture risk.Adjuvant studies to assess the prevention of bone metastases have appropriate scientific rationale, including the potential antitumor effects of bisphosphonates, but large randomized controlled trials are incomplete.

The use of a bisphosphonate is warranted for preservation of bone mineral density in women with primary breast cancer and gonadal dysfunction or drug-induced hypoestrogenism. The potential additional benefit of delay or prevention of bone metastasis awaits confirmation from randomized controlled trials.Expert consensus panels have suggested guidelines for use of bisphosphonates for prevention of cancer treatment induced bone loss.