Bisphosphonates: Prevention of Bone Metastases in Breast Cancer

Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 192)


Disease recurrence and distant metastases remain challenging for patients with breast cancer despite advances in early diagnosis, surgical expertise, and adjuvant therapy. Bone is the most common site for breast cancer metastasis, and the bone microenvironment plays a crucial role in harboring disseminated tumor cells (DTCs), a putative source of late relapse in and outside bone. Therefore, agents that affect bone metabolism might not only prevent the development of bone lesions but also provide meaningful reductions in the risk of relapse both in bone and beyond. Bisphosphonates bind to mineralized bone surfaces and are ingested by osteoclasts, wherein they inhibit osteolysis, thereby preventing the release of growth factors from the bone matrix. Therefore, the bone microenvironment becomes less conducive to survival and growth of DTCs and bone lesion formation. Recent trials of zoledronic acid in the adjuvant setting in breast cancer have demonstrated reduced disease recurrence in bone and other sites in premenopausal and postmenopausal women with early breast cancer. Based on the proven effect of bone protection during adjuvant endocrine therapy, new treatment guidelines recommend the routine use of bisphosphonates to prevent bone loss during adjuvant therapy, which may likely become the standard practice.


Adjuvant therapy Anticancer Bisphosphonate Bone metastases Breast cancer Cancer prevention Clodronate Zoledronic acid 



Austrian Breast and Colorectal Cancer Study Group


Adverse event


Aromatase inhibitor




Breast Cancer in Northern Israel Study


Beta C-terminal telopeptide of type I collagen


Bone metastases


Bone mineral density




Confidence interval




Circulating tumor cells


Cancer treatment-induced bone loss


Disease-free survival


Disseminated tumor cells


Estrogen receptor


European Society for Medical Oncology


Hypercalcemia of malignancy


Human epidermal growth factor receptor 2


Hazard ratio






Lymph node


National Cancer Institute of Canada Clinical Trials Group


Number needed to treat


None reported


Not significant


Osteonecrosis of the jaw


Overall survival


Skeletal-related events




Vascular endothelial growth factor


Women’s Health Initiative Observational Study


Zometa-Femara Adjuvant Synergy Trials


Zoledronic acid


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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of SurgeryComprehensive Cancer Center Vienna, Medical University of ViennaWienAustria
  2. 2.Department of GynecologyGynecological Endocrinology and Oncology, Philipps-University of MarburgMarburgGermany

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