**7. Summary and conclusion**

Bone health is an important topic in early and advanced breast cancer. Bisphosphonates have been established in management of metastatic disease since more than 20 years ago and have shown to clearly improve the outcome in patients with bone metastasis. Since 2010, denosumab, an RANKL antibody, was also accepted and adopted as standard of care in patients with metastatic breast cancer and bone metastasis. Both options significantly reduce skeletal-bone-related complications and are important therapeutic agents considered in metastatic breast cancer cases.

In early stages of breast cancer, bisphosphonates should be used in postmenopausal women for improved outcome (recurrence risk and bone health including prevention of osteoporosis) [14].

However, patients should be informed, before treatment initiation with these agents, about possible side effects including osteonecrosis of the jaw (ONJ), pain, and flu-like symptoms.

Nowadays, bisphosphonates and denosumab are internationally recognized as part of standard practice in breast cancer treatment, and every physician should be aware of their indications, therapy regimens, and possible complications.
