Table 3.

Summary of key clinical points and levels of evidence for adjuvant BP treatment recommendations.

Summary of key clinical points and levels of evidence for adjuvant BP treatment recommendations
Prevention of AIBL
Postmenopausal women at low risk of recurrence
–Chemotherapy unlkely to have a direct affect on bone
–Tamoxifen reduces fracture risk
–Als induce bone loss
–Assessment of fracture risk with regard to clinical risk factors, +/–BMD in accordance to position statement
–Ensure adequate calcium and vitamin D intake
–Consider Denosumab (I,A) or BPs (lll-IV, A) if T score ≤2.0 or ≥2 clinic risk factors for fracture
(BPscan include zoledronic acid (4 mg IV Q6 months) (II,A), risedronate (35 mg PO weekly) (lll,A), ibandronate (150 mg PO monthly) (IV, A) alendronate (70 mg PO weekly), (IV, A)
Prevention of metastases and improving disease outcomes
Premenopausal women on adjuvant ovarian suppression
–BPs should be considered to prevent CTIBL and metastases (l,A)
–Recommended BP is zoledronic acid [4 mg IV Q6 months) or clodronate (1600 mg PO daily) (l,A)
–BPs should be initiated at the start of adjuvant therapy (ll, A)
–Duration of BP treatment should not exceed duration of ovarian suppression unless indicated for low T-score (3-5 years) (ll,A)
Postmenopausal women at intermediate or high risk of recurrence
–BPs should be considered to prevent metastases irrespective of fracture risk (1,A)
–Recommended BPs are zoledronic acid (4 mg IV Q6 months) or clodronate (1600 mg PO daily) (1,A)
–EPs should be initiated at the start of adjuvant therapy (ll,A)
–Duration of BP treatment should be 3-5 years and only continued after 5 years if indicated by fracture risk (ll,A)

Source:Adapted by Hadji et al. [72].