Bone Density Medications

Bisphosphonate drugs are bone density medications (also called bone-modifying agents) that help prevent osteoporosis (bone loss). They are used in breast cancer treatment and care.

Breast cancer treatment

Bisphosphonates are used to treat some women with early breast cancer [10,165]. These drugs may lower the risk of breast cancer recurrence (a return of breast cancer) [74,165].

If you are postmenopausal (either naturally or through ovarian suppression) and will get chemotherapy or hormone therapy after breast surgery, your oncologist may recommend the bisphosphonate zolendronic acid (Zometa) as part of your treatment [10,165].

Zolendronic acid is given through an IV into a vein every 6 months for 3 years [10,165].

Breast cancer care

Bone density medications are used to prevent or manage side effects in:

• Women taking an aromatase inhibitor
• Women with early menopause related to breast cancer treatment
• Women with bone metastases (breast cancer that has spread to the bones)

Health risks

Before you begin treatment with zolendronic acid, talk with your oncologist about possible side effects and health risks that may occur. They can help you manage side effects.

Bone, joint or muscle pain with first treatment

Although mostly a concern for people with metastatic breast cancer who take higher doses of bisphosphonates or denosumab, these drugs can cause bone, joint and muscle pain [120,128]. This type of pain usually only lasts for 1-2 days, and only with the first treatment.

However, if you have any of these symptoms, report them to your health care provider right away.

Osteonecrosis of the jaw

Although rare, bisphosphonates can cause osteonecrosis of the jaw, a serious jawbone disorder [129]. This is mostly a concern for people with metastatic breast cancer who take frequent doses of bisphosphonates for long periods of time.

It’s recommended you have a dental exam (along with any dental work that needs to be done) before you start treatment with a bisphosphonate or denosumab [10].

Before getting any dental procedure while on bone-strengthening therapy, talk with your oncologist. Also, tell your dentist you’re on one of these medications.

Under study

The RANK ligand (RANKL) inhibitor drug denosumab is another bone density medication. It’s used to help prevent and manage bone-related side effects in women with breast cancer, including those with bone metastases.

Most studies show denosumab does not lower the risk of breast cancer recurrence in people with early breast cancer [76-77].

Learn more about denosumab in the care of people with bone metastases.

Treatment guidelines for metastatic breast cancer

Although the exact treatment for metastatic breast cancer varies from person to person, guidelines help make sure high-quality care is given. These guidelines are based on the latest research and agreement among experts.

The National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) are respected organizations that regularly review and update their guidelines.

In addition, the National Cancer Institute (NCI) has treatment overviews.

Talk with your health care team about which treatment guidelines they follow.

After you get a recommended treatment plan from your health care team, study your treatment options. Together with your health care team, make thoughtful, informed decisions that are best for you. Each treatment has risks and benefits to consider along with your own values and lifestyle.

Updated 04/09/24