Prevention

Why?

• Regular bisphosphonates reduce skeletal complications, including non-vertebral pathological fractures ^a
• Fewer patients require surgery or radiation to bone ^a
• Patients require less analgesia. ^a
• Fewer patients develop hypercalcaemia ^a
• There is no effect on mortality. ^a  

Breast cancer and bony metastases: regular bisphosphonates reduce hypercalcaemia and skeletal complications

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
breast cancer and bony metastases a	regular bisphosphonates	placebo	skeletal complication at 12 months	70%	0.63 (0.52 to 0.76)	10 (7 to 17)

Breast cancer and bony metastases: pamidronate reduces hypercalcaemia and skeletal complications

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
breast cancer and bony metastases a	pamidronate every 2 weeks	placebo	non-vertebral pathologic fracture at 12 months	30%	10% (1.3% to 19%)	10 (5 to 75)
			radiation to bone at 12 months	33%	14% (4.8% to 22%)	7 (4 to 21)
			surgery on bone at 12 months	61%	5.9% (0.91% to 11%)	17 (9 to 110)
			hypercalcaemia at 12 months	51%	6.2% (0.54% to 12%)	16 (8 to 190)