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Recommendations for use of Bisphosphonates

Unanswered questions

Important unanswered questions about the use of bisphosphonates for advanced breast cancer are outlined below. Some of these questions may be addressed in ongoing trials.

  • What is the optimal schedule and maximum duration for use of bisphosphonates?
  • How do bisphosphonates affect overall quality of life?
  • What is the impact of bisphosphonates on vitamin D and calcium levels, and what is the potential for use of vitamin D and calcium supplements?
  • What baseline tests should be used to determine who could benefit from bisphosphonates?
  • How should bisphosphonates be used at the end of life?
  • What are the relative harms/benefits of different bisphosphonates?
  • What is the relationship between bisphosphonate type and dosage and osteonecrosis of the jaw?
  • How do bisphosphonates compare with new bone acting agents?
  • How do bisphosphonates interact with newer breast cancer systemic treatments (such as targeted therapies)?
  • What is the role of biochemical markers to monitor bisphosphonate use?

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