Table 4.

Comparison of antiresorptive agents.

Agent	Advantages	Limitations	Long-term safety
Oral bisphosphonates	•Oral (self) administration	•Limited efficacy data available •Need to follow strict dosing guidelines •Poor compliance and persistence •No data for risedronate or alendronate to assess effects on underlying breast cancer	•Established in the osteoporosis setting •Generally well tolerated
IV bisphosphonates (Zoledronate)	•Efficacy data from large trials with long follow-up •Can be administered during routine twice-yearly oncologist visits •Compliance can be ensured	•IV administration by healthcare provider	•Established in the osteoporosis and AIBL settings •Generally well tolerated •Adverse events are generally mild and manageable
Denosumab	•Can be administered during routine twice-yearly oncologist visits or administration by healthcare provider •Compliance can be ensured	•Limited efficacy data available •Rebound effect after treatment termination •Costs	•Established in the osteoporosis and AIBL settings with anti-fracture efficacy in both •Generally well tolerated •Adverse events are generally mild and manageable

Abbreviations: AIBL, aromatase inhibitor-associated bone loss; IV, intravenous; sc, subcutaneous.