The role of bisphosphonates to preserve bone health in patients with breast cancer

The incidence of cancer-related deaths (including those related to breast cancer) in the United States is projected to decrease in 2006 for the first time in history (1). This milestone suggests that oncologists now have tools to prevent, diagnose, and treat cancer more effectively than ever before. However, the increase in survival for patients comes with an increased risk of long-term complications from cancer and cancer treatments. An area in which improved patient management can make an important difference is bone health. An estimated 65% to 75% of patients with advanced breast cancer develop bone metastases (2), which can have devastating consequences for their quality of life (QOL) and functional independence (3). Metastatic bone disease from breast cancer typically involves the ribs, spine, pelvis, skull, and proximal limbs (4,5), and can result in skeletal complications, termed skeletal-related events (SREs), including pathologic fracture, the need for palliative radiotherapy to bone, spinal cord compression, the need for surgery to bone to stabilize an impending fracture, and hypercalcemia of malignancy (HCM) (6). In a one-year trial in patients with bone metastases from breast cancer, approximately half of the patients who received standard anticancer therapy but no bisphosphonate treatment developed at least one SRE, and each type of SRE occurred (Fig. 1) (7). Moreover, median survival for this population is approximately two years (2,8,9). Therefore, patients typically survive long enough to experience multiple SREs from their bone lesions (2).