Improvements in the survival of patients with
breast cancer, together with a better understanding of the pathology of the disease, have led to the emergence of bone health as a key aspect of patient management. Patients with
breast cancer are typically at risk of skeletal complications throughout their disease course. The receptor activator of nuclear factor κ B
ligand (RANKL) inhibitor
denosumab and
bisphosphonates (e.g.
zoledronic acid) are approved in Europe for the prevention of skeletal-related events (
pathologic fracture, radiation or surgery to bone, and
spinal cord compression) in adults with bone
metastases secondary to solid tumours. These agents are also approved at lower doses for the treatment of patients with
postmenopausal osteoporosis, a population largely overlapping with those in the early stages of
breast cancer, and those with
cancer treatment-induced bone loss, which is caused primarily by
aromatase inhibitors. In this review, we consider the evidence supporting the use of therapeutic agents to protect bone health throughout the course of
breast cancer. Timing of treatment initiation, dose and
treatment duration may prove to be barriers to the optimization of the practical use of these agents in the management of patients with
breast cancer. Furthermore, with longer survival times, patients may expect to receive long-term treatment with
denosumab or
bisphosphonates, therefore consideration must be given to safety. Thus, we aim to summarize the recommendations for the use of these agents in management of patients with
breast cancer in Europe. We also discuss the recent evidence for their potential
antineoplastic effects.