TABLE V.

Summary of bisphosphonate use for metastatic bone disease in breast cancer patients

Placebo-controlled trials in breast cancer patients with bone metastases confirm significant reductions in the incidence and delay in the occurrence of skeletal-related events (SREs) with bisphosphonate use.

Effects of bisphosphonates are time-dependent; in terms of reducing SREs, benefits begin to be identified after 6 months of treatment.

The benefits of bisphosphonate treatment in patients with poor prognosis are mostly unknown.

Which bisphosphonate to use as first-line therapy remains to be clarified. Evidence mainly supports the use of intravenous aminobisphosphonates. However, clodronate can be offered to patients who are unable or unwilling to come to hospital for intravenous treatment.

The absolute magnitude of bisphosphonate benefit and the who, when, and how long parameters of treatment remain unclear.

A switch to a more potent bisphosphonate (zoledronic acid or ibandronate) after either a SRE or bone metastasis progression during treatment with a first-line bisphosphonate (clodronate or pamidronate) may offer better pain control.