Bisphosphonates constitute the standard treatment for
cancer hypercalcemia and prevention of complications of metastatic
bone disease. Various clinical endpoints have been used to evaluate the impact of
bisphosphonates on bone
metastases. This literature review is focused on the
analgesic effect of
bisphosphonates and their impact on quality of life (QoL) in patients with bone
metastases from
breast cancer. Twenty-five randomized trials studying
bisphosphonates with
pain and/or QoL as primary or secondary endpoints were considered. These studies were analyzed with following criterias : study type, primary
cancer,
drug scheduling, number of patients included, associated specific treatment, primary and secondary endpoints,
pain assessment, and QoL assessment. The results are in favor of an efficacy of
bisphosphonates in bone
pain, even when not always statistically significant and with an important variability in assessment criterias and tools. QoL assessment with validated, reliable scales (EORTC QLQ-C30, Rotterdam Symptom Checklist...) has been performed in 9 studies. The use of
bisphosphonates with systemic and
radiation therapy increases QoL or reduces QoL deterioration. Despite some methodological limitations, these studies indicate a beneficial effect on bone
pain, and an improvement in the QoL of patients with metastatic
bone disease of
breast cancer. Because of a lack of systemic data, reliable analysis of the results is difficult. Several questions remain open about which
bisphosphonates and route of administration to choose, and the variable effects on different primaries.