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Bone Health in Patients with Breast Cancer: Recommendations from an Evidence-Based Canadian Guideline
Tom Baker Cancer Centre, University of Calgary, 1331-29 Street NW, Calgary, AB T2N 4N2, Canada
CancerControl Alberta, Alberta Health Services, 1331-29 Street NW, Calgary, AB T2N 4N2, Canada
* Author to whom correspondence should be addressed.
Received: 9 November 2013; in revised form: 26 November 2013 / Accepted: 28 November 2013 / Published: 17 December 2013
Abstract: Bone loss is common in patients with breast cancer. Bone modifying agents (BMAs), such as bisphosphonates and denosumab, have been shown to reverse or stabilize bone loss and may be useful in the primary and metastatic settings. The purpose of this review is to provide clear evidence-based strategies for the management of bone loss and its symptoms in breast cancer. A systematic review of clinical trials and meta-analyses published between 1996 and 2012 was conducted of MEDLINE and EMBASE. Reference lists were hand-searched for additional publications. Recommendations were developed based on the best available evidence. Zoledronate, pamidronate, clodronate, and denosumab are recommended for metastatic breast cancer patients; however, no one agent can be recommended over another. Zoledronate or any oral bisphosphonate and denosumab should be considered in primary breast cancer patients who are postmenopausal on aromatase inhibitor therapy and have a high risk of fracture and/or a low bone mineral density and in premenopausal primary breast cancer patients who become amenorrheic after therapy. No one agent can be recommended over another. BMAs are not currently recommended as adjuvant therapy in primary breast cancer for the purpose of improving survival, although a major Early Breast Cancer Cooperative Trialists’ Group meta-analysis is underway which may impact future practice. Adverse events can be managed with appropriate supportive care.
Keywords: bone modifying agent; bisphosphonate; bone metastases; bone mineral density; breast cancer; adjuvant therapy; clinical practice guideline; systematic review
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MDPI and ACS Style
Paterson, A.H.G.; Shea-Budgell, M.A. Bone Health in Patients with Breast Cancer: Recommendations from an Evidence-Based Canadian Guideline. J. Clin. Med. 2013, 2, 283-301.
Paterson AHG, Shea-Budgell MA. Bone Health in Patients with Breast Cancer: Recommendations from an Evidence-Based Canadian Guideline. Journal of Clinical Medicine. 2013; 2(4):283-301.
Paterson, Alexander H.G.; Shea-Budgell, Melissa A. 2013. "Bone Health in Patients with Breast Cancer: Recommendations from an Evidence-Based Canadian Guideline." J. Clin. Med. 2, no. 4: 283-301.