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Recommendations for use of Bisphosphonates

Strengths and Weaknesses of the Evidence

The evidence included in this guideline is mostly based on randomised controlled trials. The quality of all included systematic reviews and randomised controlled trials was rated fair to good. The variations in patient populations and breast cancer treatment regimens used in each trial may impact the generalisability of some of the trial results. While participant numbers in the randomised controlled trials varied from 50 to 1,803, the majority of trials had more than 200 participants. The Cancer Australia meta-analysis results for some outcomes were influenced by one of the larger trials, ABCSG-12, which included a select population of premenopausal women treated with endocrine therapy and ovarian suppression (without adjuvant chemotherapy). Another limitation of the evidence is the paucity of information on the long-term effects of bisphosphonates on patients, as follow-up results beyond 10 years have not been reported. Information about the optimal duration and schedule of bisphosphonate treatment for women with early breast cancer is not yet available, nor is evidence available about how bisphosphonates affect quality of life for women with early breast cancer.

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