Clinical Edge

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Cochrane on Bisphosphonates for Breast Cancer

Cochrane; 2017 Oct 30; O'Carrigan, Wong, et al

Bisphosphonates reduce the risk of bone metastases in women with breast cancer and enable those who take them to live longer than those receiving placebo or no bisphosphonates, according to a Cochrane review of 44 studies involving >37,000 individuals.

In women with early breast cancer, bisphosphonates:

  • Probably lowered the risk of cancer spreading to the bone.
  • Improved survival, but the benefit in the whole group was small.
  • Improved survival and reduced the risk of cancer returning in postmenopausal women.

In women with metastatic breast cancer that spread to the bone:

  • Bisphosphonates reduced fractures and bone pain.
  • They did not appear to increase the length of time women survived.
  • Quality of life was slightly better for women who took bisphosphonates.
  • Denosumab reduced the risk of complications compared to bisphosphonates, but it did not produce a survival benefit.

In women with advanced breast cancer, bisphosphonates did not reduce the risk of cancer spreading to the bone or improve survival.


O'Carrigan B, Wong M, Willson M, Stockler M, Pavlakis N, Goodwin A. Bisphosphonates and other bone agents for breast cancer. Cochrane Database of Syst Rev. 2017, Issue 10. Art. No.: CD003474. doi:10.1002/14651858.CD003474.pub4.