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Advancements in neo(adjuvant) therapies have significantly improved outcomes, although they are often associated with cancer treatment-induced bone loss, which increases the risk of fractures and negatively impacts quality of life. Bone-modifying agents (BMAs), such as bisphosphonates and denosumab can mitigate this adverse effect. By reviewing and summarizing the most recent evidence published on BMAs use in EBC, an expert Italian Panel, composed of the authors of the Italian Association of Medical Oncology (AIOM) guidelines, offers an extended clinical interpretation and updated overview of key questions and recommendation, including the optimal timing of BMAs initiation, appropriate treatment duration, and the most effective agents for fracture risk reduction. Additionally, a critical and previously unaddressed topic is also discussed: BMAs impact on survival outcomes in EBC scenario. 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