Table 2. The included studies’ characteristics.
# | Author | Year | Country | Study design | The regimen of control group | Type of BP | Type of breast cancer | Mean age | Menstruation | Case (n) | Control (n) | F/U (mon) | Duration of BP use (mon) | HER2 | PR | ER |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Korde et al. [28] | 2017 | USA | Cohort study | Hormone therapy | Alendronate, risedronate, zoledronate | AJCC stage | 64.2 | Post: 1,527, Pre: 191 | 302 | 1,511 | 11.8 | 41.2 | - | BP: PR+: 238, PR−: 56 | BP: ER+: 257, ER−: 37 |
BP: I: 172, IIA: 57, IIB: 15, IIIA: 23, IIIB: 6 | Post: 266 | Post: 1,261 | Control: PR+: 1,131, PR−: 345 | Control: ER+: 1,269, ER−: 209 | ||||||||||||
Control: I: 788, IIA: 299, IIB: 154, IIIA: 114, IIIB: 38 | ||||||||||||||||
2 | Rack et al. [22] | 2010 | Germany | Non-randomized phase II trial | Cytostatic treatment, hormone therapy | Zoledronate | G1–G3 | 53.1–54.2 | Post: 107, Pre: 49 | 31 | 141 | 39 | 6 | - | - | - |
Post: 89 | Post: 18 | |||||||||||||||
3 | Hadji et al. [20] | 2013 | Germany | Retrospective | Endocrine therapy - chemotherapy | Alendronate, clodronate, ibandronate, zoledronic acid | Stage | 59.5–64.9 | - | 937 | 630 | 12–24 | 3 ≤ | Case: 125, Control: 75 | Case: 937, Control: 630 | Case: 937, Control: 630 |
T1: BP: 620, control: 401 | ||||||||||||||||
Zoledronic acid 4 mg IV two to three times per year; ibandronate 50 mg/day PO, 150 mg/month PO, or 4 mg to 6 mg IV every 3 months; clodronate 1,600 mg/day PO; or alendronate 70 mg/week PO. | T2, 3, or 4: BP: 317, control: 229 | HER2−: BP: 750, Control: 517 | ||||||||||||||
Nodal | ||||||||||||||||
N0: BP: 537, control: 413 | ||||||||||||||||
N+: BP: 400, control: 217 | ||||||||||||||||
Histologic grade | ||||||||||||||||
BP: G1,G2: 662, G3: 275 | ||||||||||||||||
Control: G1,G2: 421, G3: 209 | ||||||||||||||||
4 | Gnant et al. [26] | 2014 | Italy | RCT | Goserelin, tamoxifen, anastrozole | Zoledronic acid, 4 mg given intravenously every 6 months) | T1–T3 | 45–45.5 | Post: 5, Pre: 1,798 | 900 | 903 | 94.4 | 36 | - | Case: 803, Control: 804 | Case: 835, Control: 848 |
Post: 2 | Post: 3 | |||||||||||||||
5 | Coleman et al. [31] | 2018 | UK | Randomized controlled, phase 3 | Standard adjuvant systemic therapy | Zoledronic acid, 4 mg zoledronic acid given intravenously every 3–4 weeks for the first six doses, every 3 months for eight doses, and every 6 months for five doses to complete 5 years of treatment | Grade | 18 ≤ | Pre: 1,503, Post: 1,532 | 1,681 | 1,678 | 117 | 60 | BP: HER2+: 192, HER2−: 648 | BP: PR+: 725, PR−: 382 | BP: ER+: 1,318, ER−: 350 |
BP: I: 146, II: 731, III: 765 | Post: 766 | Post: 765 | Control: HER2+: 223, HER2−: 604 | Control: PR+: 699, PR−: 424 | Control: ER+: 1,315, ER−: 356 | |||||||||||
Control: I: 141, II: 708, III: 787 | ||||||||||||||||
Node | ||||||||||||||||
BP: 0: 30, 1–3: 1,042, ≥4: 604 | ||||||||||||||||
Control: 0: 32, 1–3: 1,033, ≥4: 607 | ||||||||||||||||
Stage | ||||||||||||||||
BP: I: 542, II: 850, III: 228, IV: 58 | ||||||||||||||||
Control: I: 523, II: 867, III: 228, IV: 59 | ||||||||||||||||
6 | Paterson et al. [29] | 2012 | USA | Multicentre, placebo-controlled, randomised trial | Endocrine therapy - chemotherapy | Clodronate, 1,600 mg daily for 3 years | Nodal | 49 ≥ to 50 ≤ | - | 1,656 | 1,655 | 90.7 | 36 | - | - | - |
1–3: BP: 18, control: 295 | ||||||||||||||||
4 or more: BP: 7, control: 114 | ||||||||||||||||
7 | Perrone et al. [30] | 2019 | Italy | Phase 3 randomised trial | Letrozole, tamoxifen | Zoledronic acid | G1–G3 | 44.7–45.2 | Pre: 1,065 | 355 | 710 | 64 | 60 | Case: 47, Control: 98 | Case: 346, Control: 685 | - |
8 | Banys et al. [24] | 2013 | Germany | Controlled randomized open-label multi-center study | Endocrine treatment chemotherapy | Zoledronic acid, intravenous zoledronic acid every 4 weeks for 24 months | Grading | - | Pre: 55, Post: 31 | 40 | 46 | 88 | 24 | BP: HER2+: 5, HER2−: 30 | BP: PR+: 24, PR−: 11 | BP: ER+: 30, ER−: 5 |
BP: I/II: 33, III: 5 | Post: 26 | Post: 29 | Control: HER2+: 5, HER2−: 28 | Control: PR+: 23, PR−: 11 | Control: ER+: 30, ER−: 4 | |||||||||||
Control: I/II: 35, III: 5 | ||||||||||||||||
Nodal+: BP: 4, control: 6 | ||||||||||||||||
Nodal−: BP: 35, control: 35 | ||||||||||||||||
9 | Ishikawa et al. [27] | 2017 | Japan | Randomized phase II trial | FEC100 Paclitaxel | Zoledronic acid, (4 mg) 3–4 times weekly for 7 weeks | IIA–IIIB | 20–70 | - | 93 | 95 | 36 | 36–60 | Case: 0, Control: 0 | - | - |
(T ≥ 3.0 cm and node negative, or T ≥ 2.0 cm and cytologically or pathologically defined as node positive) Zoledronic acid (4 mg) 3–4 times weekly for 7 weeks | ||||||||||||||||
10 | Powles et al. [34] | 2006 | UK | Randomized double-blind, placebo-controlled trial | Chemotherapy tamoxifen | Clodronate, 1,600 mg/day during a 2 year | Stage 1–3 | 52.8 ± 10.6 | Pre: 530, Post: 539 | 530 | 539 | 67.2 | 24 | - | BP: PR+: 112, PR−: 79 | BP: ER+: 245, ER−: 136 |
BP: TI: 137, TII: 304, TIII: 48 | 52.7 ± 10.5 | Post: 265 | Post: 274 | Control: PR+: 116, PR−: 75 | Control: ER+: 240, ER−: 136 | |||||||||||
Control: TI: 143, TII: 305, TIII: 52 | ||||||||||||||||
11 | Aft et al. [32] | 2010 | USA | Open label, randomised, phase 2 trial | Epirubicin, docetaxel | Zoledronic acid, 4mg intravenous ZOL every 3 weeks for 1 year (total 17 doses) | BP: GI: 7, GII: 20, GIII: 33 | 18–56 | Pre: 64, Post: 55 | 60 | 59 | 60 | 12 | Case: 13, Control: 10 | BP: PR+: 24, PR−: | BP: ER+: 32, ER−: 28 |
Control: GI: 2, GII: 28, GIII: 29 | Post: 29 | Post: 26 | Control: PR+: 31, PR−: | Control: ER+: 34, ER−: 28 | ||||||||||||
12 | Kristensen et al. [38] | 2008 | Sweden | Randomized Clinical trial | CMF, CEF | Pamidronate, 150 mg twice daily for 4 years | BP: GI: 35, GII: 181, GIII: 151 | 39 ≥ to 69 | Pre: 634, Post: 318 | 460 | 493 | 120 ≤ | 36 | - | BP: PR+: 51, PR−: 135 | BP: ER+: 62, ER−: 278 |
Control: GI: 23, GII: 202, GIII: 168 | Post: 152 | Post: 166 | Control: PR+: 54, PR−: 136 | Control: ER+: 85, ER−: 261 | ||||||||||||
13 | Body et al. [37] | 2003 | USA | Double-blind, placebo-controlled, parallel-group, multicentre, phase III study | Endocrine treatment chemotherapy | Gp1: Ibandronate (2 mg) (n = 154), Gp2: Ibandronate (6 mg) (n = 154), every 3–4 weeks for up to 2 years | - | 55.3 | - | Gp1: 154 | 158 | 12.67 | 19.5 | - | - | - |
Gp2: 154 | ||||||||||||||||
14 | Delmas et al. [19] | 1997 | UK | Double-Blind, Placebo-Controlled | Placebo | Risedronate, eight cycles oral risedronate 30 mg/d daily for 2 weeks followed by 10 weeks of no drug (12 weeks per cycle) | - | 36–55 | Pre: 0, Post: 53 | 27 | 26 | 36 | 36 | - | - | - |
Post: 27 | Post: 0 | |||||||||||||||
15 | Eidtmann et al. [25] | 2010 | UK | Open-label, multicenter, randomized study | Letrozole | Zoledronic acid, immediate zoledronic acid (ZOL; 4 mg every 6 months) or delayed ZOL (initiated only for fracture or high risk thereof) | Stage I–IIIa | 58 | Post: 884, Pre: 176 | 524 | 536 | 36 | 11.84 | - | - | - |
Post: 438 | Post: 448 | |||||||||||||||
16 | Diel et al. [33] | 1998 | Germany | Prospective, randomized, non–placebo-controlled study | Tamoxifen, CMF, CEF | Clodronate, 1,600 mg of oral clodronate per day for two years | BP: T1: 59, T2: 71, T3: 17, T4: 10 | 51 | Post: 189, Pre: 113 | 157 | 145 | 36 | 24 | - | BP: PR+: 85, PR−: 51 | BP: ER+: 104, ER−: 35 |
Control: T1: 54, T2: 67, T3: 18, T4: 6 | Post: 101 | Post: 88 | Control: PR+: 72, PR−: 42 | Control: ER+: 84, ER−: 34 | ||||||||||||
Nodal | ||||||||||||||||
BP: N0: 77, N1 or N2: 80 | ||||||||||||||||
Control: N0: 66, N1 or N2: 79 | ||||||||||||||||
G1, or II: BP: 93, control: 92 | ||||||||||||||||
GIII: BP: 44, control: 34 | ||||||||||||||||
17 | Saarto et al. [35] | 2003 | Finland | Randomized Controlled Trial | CMF | Clodronate, 1,600 mg daily for 3 years | BP: T1: 71, T2: 59, T3: 9 | 52 | Post: 134, Pre: 148 | 139 | 143 | 120 | 36 | - | BP: PR+: 70, PR−: 62 | BP: ER+: 85, ER−: 48 |
Control: T1: 66, T2: 65, T3: 9 | Post: 72 | Post: 62 | Control: PR+: 86, PR−: 44 | Control: ER+: 97, ER−: 33 | ||||||||||||
18 | Ahn et al. [23] | 2014 | Korea | Retrospective | Aromatase inhibitors | Zoledronic acid, 4 mg of ZA was administered intravenously every 3 to 6 months | Histologic grade | 56–57 | Post: 235 | 77 | 158 | 68 | 45 | Case: 13, Control: 30 | Case: 64, Control: 132 | Case: HER+: 74, HER−: 3 |
BP: I or II: 61, III: 8 | Post: 77 | Post: 158 | Control: HER+: 148, HER−: 10 | |||||||||||||
Control: I or II: 130, III: 19 | ||||||||||||||||
T stage | ||||||||||||||||
BP: T1: 57, T2: 19, T3: 1 | ||||||||||||||||
Control: T1: 101, T2: 55, T3: 2 | ||||||||||||||||
N stage | ||||||||||||||||
BP: N0: 50, N1: 20, N2: 7, N3: 0 | ||||||||||||||||
Control: N0: 90, N1: 55, N2: 9, N3: 4 | ||||||||||||||||
Stage | ||||||||||||||||
BP: SI: 39, SII: 31, SIII: 7 | ||||||||||||||||
Control: SI: 59, SII: 85, SIII: 14 | ||||||||||||||||
19 | Jallouk et al. [21] | 2021 | USA | Randomized placebo-controlled phase II clinical trial in | Chemotherapy | Zoledronic acid, 4 mg intravenous ZOL every 3 weeks for 1 year (17 total doses) | Stage II–III (≥T2 and/or ≥N1) | 47–49 | Post: 55, Pre: 64 | 60 | 59 | 172.8 | 12 | Case: 13, Control: 10 | Case: 24, Control: 31 | Case: 32, Control: 34 |
Grade | Post: 29 | Post: 26 | ||||||||||||||
BP: GI: 7, GII: 20, GIII: 33 | ||||||||||||||||
Control: GI: 2, GII: 28, GIII: 29 | ||||||||||||||||
20 | Aft et al. [39] | 2012 | USA | Randomized clinical trial | Chemotherapy | Zoledronic acid, 4 mg intravenous ZOL every 3 weeks for 1 year (total 17 doses) | Stage II–III | 49–50 | Post: 55, Pre: 64 | 59 | 60 | 61.9 | 12 | Case: 13, Control: 10 | - | Case: 32, Control: 34 |
Grade I: 7 in BP; 2 in control | Post: 26 | Post: 29 | ER+/HER2+: 6 in BP; 5 in control | |||||||||||||
Grade II: 20 in BP; 28 in control | ER+/HER2−: 26 in BP; 29 in control | |||||||||||||||
Grade III: 33 in BP; 29 in control | ER−/HER2+: 7 in BP; 5 in control | |||||||||||||||
ER−/HER2−: 21 in BP; 19 in control | ||||||||||||||||
21 | von Minckwitz et al. [36] | 2013 | Germany | Open-label, randomized, controlled phase III trial | Observation | Ibandronate | Tumor stage | 40–60 | Post: 1,549, Pre: 1,431 | 1996 | 998 | 38.7 | 24 | BP: HER2+: 415, HER2−: 1,467 | - | - |
BP: pT1: 635, pT2: 1,112, pT3: 202, pT4: 41 | Post: 1,023 | Post: 526 | ||||||||||||||
Control: pT1: 320, pT2: 557, pT3: 103, pT4: 14 | ||||||||||||||||
Grade | ||||||||||||||||
BP: G1: 63, G2: 987, G3: 943 | ||||||||||||||||
Control: G1: 33, G2: 520, G3: 442 | ||||||||||||||||
Node | ||||||||||||||||
BP: N1: 7,361, N2: 696, N3: 539 | ||||||||||||||||
Control: N1: 370, N2: 362, N3: 266 |
BP = bisphosphonate; F/U = follow-up; HER2 = human epidermal growth factor receptor 2; PR = progesterone receptor; ER = estrogen receptor; AJCC = American Joint Committee on Cancer; PO = per os; RCT = randomized controlled trial; CMF = cyclophosphamide, methotrexate, fluorouracil; CEF = cyclophosphamide, epirubicin, and fluorouracil.