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 [11,178]. These drugs may lower the risk of breast cancer recurrence (a return of breast cancer) [86,178].

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 [11,178].

Zolendronic acid is given through an IV into a vein every 6 months for 3 years [11,178].

Talk with your health care provider if you have any questions or concerns about your medications.

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 get higher doses of bisphosphonates, these drugs can cause bone, joint and muscle pain [130,138]. 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 [139]. This is mostly a concern for people with metastatic breast cancer who take frequent doses of bisphosphonates for long periods of time [179].

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 [11].

Talk with your dentist before getting any dental work while you’re on a bisphosphonate and tell them you are on this medication. Routine dental cleanings are safe for people on a bisphosphonate.

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. It has the same health risks mentioned above.

Most studies show denosumab does not lower the risk of breast cancer recurrence in people with early breast cancer [88-89].

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

Treatment guidelines

Although the exact treatment for breast cancer varies from person to person, evidence-based 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 03/03/25

This content is regularly reviewed by an expert panel including researchers, practicing clinicians and patient advocates.