Treatment of Bone Metastases in Breast Cancer: an Update

Bone is the most common site of breast cancer metastases. When breast cancer has metastasized to bone, it is considered an incurable disease. Osseous metastases are associated with significant morbidities including pain, pathological fractures, hypercalcemia of malignancy, and spinal cord compression. In this setting, the palliative goals of care include preventing skeletal related events, managing complications, reducing bone pain, and improving quality of life. Antiresorptive agents such as bisphosphonates have been the mainstay of bone-directed treatment, along with radiation therapy, and surgery. Most recently, RANKL-inhibitors have become another tool in the treatment of bone metastases. This review discusses bone-modifying agents and other targeted interventions in breast cancer patients with skeletal metastases.