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Starting bisphosphonates in women who demonstrate bone destruction through imaging but who have normal plain radiographs is considered reasonable treatment. Starting bisphosphonates in women with only an abnormal bone scan but without evidence of bone destruction is not recommended. The presence or absence of bone pain should not be a factor in initiating bisphosphonates. <\/jats:p><jats:p> In patients with a serum creatinine less than 3.0 mg\/dL (265 \u03bcmol\/L), no change in dosage, infusion time, or interval is required. Infusion times less than 2 hours with pamidronate or less than 15 minutes with zoledronic acid should be avoided. Creatinine should be monitored before each dose of either agent in accordance with US Food and Drug Administration (FDA) labeling. <\/jats:p><jats:p> Oncology professionals, especially medical oncologists, need to take an expanded role in the routine and regular assessment of the osteoporosis risk in women with breast cancer. The panel recommends an algorithm for patient management to maintain bone health. <\/jats:p><jats:p> Conclusion: Bisphosphonates provide a supportive, albeit expensive and non\u2013life-prolonging, benefit to many patients with bone metastases. Current research is focusing on bisphosphonates as adjuvant therapy. Although new data addressing when to stop therapy, alternative doses or schedules for administration, and how to best coordinate bisphosphonates with other palliative therapies are needed, they are not currently being investigated. <\/jats:p>","DOI":"10.1200\/jco.2003.08.017","type":"journal-article","created":{"date-parts":[[2003,9,9]],"date-time":"2003-09-09T02:19:49Z","timestamp":1063073989000},"page":"4042-4057","source":"Crossref","is-referenced-by-count":774,"title":["American Society of Clinical Oncology 2003 Update on the Role of Bisphosphonates and Bone Health Issues in Women With Breast Cancer"],"prefix":"10.1200","volume":"21","author":[{"given":"Bruce E.","family":"Hillner","sequence":"first","affiliation":[{"name":"From the American Society of Clinical Oncology, Alexandria, Virginia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James N.","family":"Ingle","sequence":"additional","affiliation":[{"name":"From the American Society of Clinical Oncology, Alexandria, Virginia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rowan T.","family":"Chlebowski","sequence":"additional","affiliation":[{"name":"From the American Society of Clinical Oncology, Alexandria, Virginia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Gralow","sequence":"additional","affiliation":[{"name":"From the American Society of Clinical Oncology, Alexandria, Virginia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary C.","family":"Yee","sequence":"additional","affiliation":[{"name":"From the American Society of Clinical Oncology, Alexandria, Virginia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora A.","family":"Janjan","sequence":"additional","affiliation":[{"name":"From the American Society of Clinical Oncology, Alexandria, Virginia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane A.","family":"Cauley","sequence":"additional","affiliation":[{"name":"From the American Society of Clinical Oncology, Alexandria, Virginia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent A.","family":"Blumenstein","sequence":"additional","affiliation":[{"name":"From the American Society of Clinical Oncology, Alexandria, Virginia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy S.","family":"Albain","sequence":"additional","affiliation":[{"name":"From the American Society of Clinical Oncology, Alexandria, Virginia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan","family":"Lipton","sequence":"additional","affiliation":[{"name":"From the American Society of Clinical Oncology, Alexandria, Virginia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Brown","sequence":"additional","affiliation":[{"name":"From the American Society of Clinical Oncology, Alexandria, Virginia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1007\/s005200100292"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2002.06.037"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(20010401)91:7<1191::AID-CNCR1119>3.0.CO;2-0"},{"key":"R4","unstructured":"Rosen LS, Gordon D, Kaminski M, et al: Zoledronic acid versus pamidronate in the treatment of skeletal metastases in patients with breast cancer or osteolytic lesions of multiple myeloma: a phase III, double-blind, comparative trial. 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