A Cochrane review [Abstract] 1 included 44 studies. In patients with advanced breast cancer and bone metastases (9 studies, 2810 women), bisphosphonates reduced the risk of developing a skeletal event by 14% , increased the time to skeletal event, and reduced bone pain compared with placebo or no bisphosphonates T1.
| Outcome (Follow-up 12 months to 24 months) | Relative effect(95% CI) | Risk with placebo/observation | Risk with intervention - bisphosphonates (95% CI) | №of participants(studies) Quality of evidence |
|---|---|---|---|---|
| Skeletal-related event | RR 0.86(0.78 to 0.95) | 640 per 1000 | 550 per 1000(499 to 608) | 2810(9) High |
| Median time to a skeletal-related event | Median ratio 1.43 (1.29 to 1.58) | 4.9 to 14.9 months | 8.7 to 20.8 months | 2810(9) High |
| Overall survival (Risk of death) | RR 1.01(0.91 to 1.11) | 575 per 1000 | 581 per 1000(523 to 638) | 1935(7) Moderate |
| Bone pain(Brief Pain Inventory,VAS and other validated or unvalidated scales | - | Bone pain was significantly reduced compared to placebo (in 6 out of 11 studies) and was reduced inon-significantly in another 3 studies | 3297(11) Moderate | |
In postmenopausal women with early breast cancer bisphosphonates reduced the incidence of bone metastases and increased overall survival. However this was a post-hoc subgroup analysis.
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