How to choose the bone modifying treatment for early stage and locally advanced breast cancer?

Introduction: Breast cancer continues to be the most frequent malignancy in women worldwide. Considerable advances in oncology over the years have led to decreased mortality in early stage (EBC) and locally advanced (ABC) breast cancer, but this has raised concerns about possible long-term effects of anticancer treatment nonetheless.

Purpose: The present paper aims to describe the efficacy and safety of osteoclast inhibitors, both as antiresorptive agents, reducing osteoporosis and fracture risk, and as adjuvant anticancer agents, potentially improving disease-related outcomes in patients with early stage and locally advanced breast cancer.

Materials and methods: In this article, literature sources were selected and evaluated using the PRISMA 2020 guideline.

Conclusions: Bisphosphonates are recommended for early stage and advanced breast cancer patients, either premenopausal or postmenopausal, with osteoporosis. Denosumab may also be used for postmenopausal women. Bisphosphonates also showed a statistically significant benefit for overall survival in postmenopausal women only. However, denosumab is not presently used for indications other than prevention or treatment of osteoporosis.