Bisphosphonates for primary breast cancer

Bisphosphonates are drugs that help to strengthen bones.

If you have primary breast cancer, you may be given bisphosphonates to reduce the risk of breast cancer spreading to the bones and other parts of the body.

Zoledronic acid (Zometa) is the most commonly used bisphosphonate for primary breast cancer.

Other bisphosphonates include ibandronic acid (Bondronat) and sodium clodronate (Loron).

Your treatment team will explain which drug they recommend for you.

Other uses of bisphosphonates

As well as being used for primary breast cancer, zoledronic acid and other bisphosphonates may also be prescribed:

• For people who are at risk of, or who have, osteoporosis

• As treatment for metastatic (secondary) breast cancer in the bone

Bisphosphonates slow down or prevent loss of bone tissue. You may hear these drugs called bone-strengthening treatment.

In our bodies, whether we have cancer or not, bone tissue continually breaks down and is replaced with new bone tissue. This is a natural process called bone remodelling.

Breast cancer cells seem more likely to spread to areas where bone remodelling takes place. This is why, if breast cancer spreads, it commonly affects the bones.

Bisphosphonates are absorbed in areas of the body where there’s a lot of bone remodelling. This may help reduce the risk of breast cancer spreading to the bones.

You may be prescribed bisphosphonates if you’ve been through the menopause (postmenopausal). They can be given whether the menopause happened naturally or because of breast cancer treatment.

If you haven’t been through the menopause or you’re a man with primary breast cancer, bisphosphonates won’t benefit you.

Bisphosphonates may be prescribed if:

• You’ve had treatment for invasive breast cancer that has spread to the lymph nodes under the arm

• You don’t have cancer in your lymph nodes, but have other factors that could increase the risk of cancer returning

You’ll usually start bisphosphonates for primary breast cancer within 3 months of your final surgery.

If you’re having chemotherapy after surgery, you’ll usually start bisphosphonates within 2 months of finishing chemotherapy. You may have the first bisphosphonate treatment with your last cycle of chemotherapy.

The bisphosphonate you’re given will depend on what your treatment team suggests and what your preferences are.

Zoledronic acid is given as a drip (infusion) into a vein in your hand or arm (intravenously). You usually have an infusion every 6 months for 3 to 5 years.

Sodium clodronate and ibandronic acid are taken as a tablet.

Different bisphosphonates can cause different side effects. Your treatment team will explain them to you when you know which one you will have.

You can read more about side effects in our information on zoledronic acid.

If you have any worries or questions about bisphosphonates, you can call our nurses free on 0808 800 6000 to talk through your concerns. You can also email nurse@breastcancernow.org

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