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Practice Point
Treatment-induced bone loss – Management
Consider the use of zoledronic acid or denosumab for the management of treatment-induced bone loss in patients with breast cancer.
Bisphosphonates are also recommended in patients with treatment-related bone loss (Level of evidence – I)
Strong evidence for efficacy with a substantial clinical benefit, strongly recommended
A "moderate" rating was assigned if the consensus was less than 90%
How this guidance was developed
This recommendation was initially developed as a practice point due to the lack of evidence-based source recommendation at the commencement of the Guidance development process. It was subsequently adapted from a source recommendation in the ESMO 2019 clinical practice guidelines (date and method of evidence review not indicated), which was graded ’A’. The recommendation was expanded to include denosumab as well as the bisphosphonate zoledronic acid, as supported by the evidence that it reduces clinical fractures.
The recently released ASCO 2020 guideline on the management of male breast cancer is noted. This guideline, based on a systematic review of the evidence to 20 September 2019, indicates that ‘Men with early-stage breast cancer should not be treated with bone-modifying agents to prevent recurrence but could still receive these agents to prevent or treat osteoporosis’ (Type: formal consensus; Evidence quality: low; Strength of recommendation: moderate).
Treatment-induced bone loss – Management
Practice Point
Consider the use of zoledronic acid or denosumab for the management of treatment-induced bone loss in patients with breast cancer.
Principles in action
Discuss out of pocket costs
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Supportive care
This recommendation was initially developed as a practice point due to the lack of evidence-based source recommendation at the commencement of the Guidance development process. It was subsequently adapted from a source recommendation in the ESMO 2019 clinical practice guidelines (date and method of evidence review not indicated), which was graded ’A’. The recommendation was expanded to include denosumab as well as the bisphosphonate zoledronic acid, as supported by the evidence that it reduces clinical fractures.
The recently released ASCO 2020 guideline on the management of male breast cancer is noted. This guideline, based on a systematic review of the evidence to 20 September 2019, indicates that ‘Men with early-stage breast cancer should not be treated with bone-modifying agents to prevent recurrence but could still receive these agents to prevent or treat osteoporosis’ (Type: formal consensus; Evidence quality: low; Strength of recommendation: moderate).