What is the role of bisphosphonate therapy in bone health management of breast cancer?

Updated: Nov 06, 2019
  • Author: Winston W Tan, MD, FACP; Chief Editor: Marie Catherine Lee, MD, FACS  more...
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Answer

Bisphosphonates, which inhibit resorption of bone by osteoclasts, have been studied extensively in breast cancer. Bisphosphonates can delay the development of skeletal-related events in women with metastatic breast cancer and show promise in preventing bone loss induced by chemotherapy or hormonal therapy. Emerging data suggest that adjuvant therapy with bisphosphonates may prevent disease recurrence and prolong survival, specifically in postmenopausal women. [4]

The Early Breast Cancer Trialists' Collaborative Group found that in postmenopausal women with early breast cancer, adjuvant bisphosphonate therapy produced highly significant reductions in recurrence (rate ratio [RR] 0.86, P=0.002), distant recurrence (RR 0.82, P=0.0003), bone recurrence (RR 0.72, P=0.0002), and breast cancer mortality (RR 0.82, P=0.002). In premenopausal women, however, bisphosphonate treatment had no apparent effect on any outcome. [5]

In the setting of metastatic disease, bisphosphonates have little or no effect on survival. However, intravenously administered bisphosphonates do appear to provide a continuous effect on bone for the duration of their use.

In general, adverse effects for bisphosphonates include bone, joint, or muscle pain, as well as nausea, vomiting, and diarrhea. Oral bisphosphonates pose a higher risk of heartburn and esophagitis than their intravenously administered counterparts.


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