From the Guidelines
Bisphosphonates are not contraindicated in patients with osteoporosis and a history of breast cancer, but their use should be approached with caution.
Key Considerations
- Patients with a history of breast cancer should be evaluated on a case-by-case basis, considering the type of breast cancer, treatment received, and current disease status 1.
- Bisphosphonates such as alendronate, ibandronate, risedronate, and zoledronic acid can be considered for osteoporosis treatment in these patients 1.
- It is essential to monitor for potential side effects, particularly:
- Jaw osteonecrosis
- Atypical femoral fractures
- Hypocalcemia 1.
- The benefits and risks of bisphosphonate therapy should be carefully weighed, and alternative treatments, such as denosumab, may be considered in certain cases 1.
Additional Recommendations
- A dental examination and preventive dentistry intervention are recommended before treatment with intravenous bisphosphonates 1.
- Patients should be advised against unnecessary invasive oral surgery while on bisphosphonate therapy.
- Calcium and vitamin D supplementation should be optimized when starting any bisphosphonate therapy 1.
From the Research
Bisphosphonates in Patients with Osteoporosis and Breast Cancer History
- There is no direct evidence to suggest that bisphosphonates are contraindicated in patients with osteoporosis and a history of breast cancer 2, 3, 4, 5, 6.
- Bisphosphonates have been shown to reduce the risk of skeletal complications and bone pain in breast cancer patients 3, 5.
- The benefits of bisphosphonate therapy in preventing fractures and reducing morbidity and mortality in patients with osteoporosis may outweigh the risks of adverse effects, including osteonecrosis of the jaw and atypical femur fractures 2, 4, 6.
- Patients with a history of breast cancer and osteoporosis should be evaluated on an individual basis to determine the potential benefits and risks of bisphosphonate therapy 4, 6.
- The use of bisphosphonates in patients with breast cancer and osteoporosis requires careful consideration of the potential risks and benefits, as well as ongoing monitoring for adverse effects 5.