Managing Skeletal-Related Events in Breast Cancer, Part II

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One of the challenges facing the management of skeletal-related events (SREs) is determining the correct antiresorptive therapy and setting for women with breast cancer. Further complicating the issue, varying data and controversy exist concerning the use of calcium, vitamin D, and bisphosphonates.

Christy A. Russell, MD, notes that she uses the NCCN guidelines for clues about possible therapy options. In general, Russell notes that she waits until patients have become significantly osteopenic before initiating treatment with an oral bisphosphonate. She adds that in general a majority of patients are not taking calcium and vitamin D, which further complicates matters.

Debu Tripathy, MD, agrees that replacing calcium and vitamin D is an essential part of the equation that has become a controversial issue. He adds that evidence on the use of vitamin D is mixed, not just in terms of bone health but also concerning lowering breast cancer risk. Linda T. Vahdat, MD, notes that simple management of vitamin D deficiency can be handle by the oncologist and she recommends more complicated cases be referred to a specialists.

Tripathy notes that information regarding administering adjuvant bisphosphonates is mixed. In general, the panel agrees that these agents seem to be most effective in postmenopausal women or in the high-risk setting but may result in complications in younger premenopausal women.

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