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Recommendations for use of Bisphosphonates

Strengths and weaknesses of evidence

The overall quality of the evidence included in the guideline was good, including a meta-analysis of randomised controlled trials conducted by Cochrane.2 Whilst participant numbers in the Cochrane review varied (331130), 50% of studies had more than 200 participants.

A major limitation of the evidence is the variation in reporting and assessment of quality of life and adverse events (particularly pain) between trials. While five full text papers and one abstract describing randomised controlled trials investigating bisphosphonates for advanced breast cancer have been published since the last update of the Cochrane review in 2007, most were limited by relatively small number of patients and short treatment and follow-up times. Information about optimal timing and duration of bisphosphonate treatment is not yet available and there is limited evidence about the association between bisphosphonates and osteonecrosis of the jaw.

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