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Recommendations for use of Bisphosphonates

Clinical Practice Recommendations

The recommendations are based on the statements of current evidence for use of bisphosphonates in women treated for early breast cancer.

Recommendations to individuals should be based on their circumstances, the absolute benefits and harms of treatment, and their personal preferences. These factors should be discussed with the woman.3

In women with early breast cancer who are receiving or have received systemic therapy:
Bone health
Short-term use of bisphosphonates (up to 4 years) should be considered to reduce loss of bone mineral density in lumbar spine, hip and femoral neck associated with treatment for early breast cancer (chemotherapy, endocrine therapy) II McCloskey,5
Schedule and duration of administration
In postmenopausal women with osteopenia, upfronta intravenous zoledronic acid (4mg every 6 months) should be considered over delayedb treatment to prevent bone mineral density loss associated with aromatase inhibitor treatment for breast cancer II Z-FAST/ZO-FAST13
Adverse events
A dental check up prior to commencing bisphosphonates should be considered   Edwards,14
Women taking bisphosphonates should be routinely informed of the need for good oral health and monitored for osteonecrosis of the jaw   Khosla16
The serum creatinine levels of women taking intravenous zoledronic acid should be monitored for renal toxicity at baseline, before each infusion and at the final visit  


Clinicians should conduct a bone mineral density scan prior to prescribing bisphosphonates

Clinicians should be aware of baseline tests (biochemistry including creatinine, serum calcium and vitamin D) and contraindications prior to prescribing bisphosphonates

Women taking bisphosphonates should be reviewed regularly and monitored for adverse events by clinicians familiar with the use of bisphosphonates    

a The upfront groups received intravenous zoledronic acid immediately after random assignment.
b The delayed groups received intravenous zoledronic acid when either post-baseline lumbar spine or total hip T score decreased to less than -2.0 or a non-traumatic clinical fracture occurred.

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