Bone targeted therapies in early breast cancer

Bisphosphonates have emerged as an important tool in the supportive care of women with early breast cancer. Whereas traditionally, these drugs have been part of the treatment of osseous metastasis, the key role of bisphosphonates in preserving bone health in patients with early breast cancer cannot be overemphasised. Currently the most established use of bisphosphonates in early breast cancer patients is in women receiving hormonal blockade, mostly aromatase inhibitors (AI), with concomitant osteopenia. To that end, it is recommended that every woman undergo a Dual Energy X-Ray absorptiometry (DEXA) scan before commencement of an AI and annually during the treatment duration. In addition, unless contraindicated, all women should receive calcium and Vitamin D supplementation. The use of bisphosphonates as part of the adjuvant therapy strategy, regardless of baseline bone density condition, has produced thought-provoking results, although this is not yet considered standard clinical practise.