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In this guideline, postmenopausal includes patients with natural menopause or that induced by ovarian suppression or ablation. Absolute benefit is greater in patients who are at higher risk of recurrence, and almost all trials were conducted in patients who also received systemic therapy. Most studies evaluated zoledronic acid or clodronate, and data are extremely limited for other bisphosphonates. While denosumab was found to reduce fractures, long-term survival data are still required. <\/jats:p><\/jats:sec><jats:sec><jats:title>Recommendations<\/jats:title><jats:p> It is recommended that, if available, zoledronic acid (4 mg intravenously every 6 months) or clodronate (1,600 mg\/d orally) be considered as adjuvant therapy for postmenopausal patients with breast cancer who are deemed candidates for adjuvant systemic therapy. Further research comparing different bone-modifying agents, doses, dosing intervals, and durations is required. Risk factors for osteonecrosis of the jaw and renal impairment should be assessed, and any pending dental or oral health problems should be dealt with prior to starting treatment. Data for adjuvant denosumab look promising but are currently insufficient to make any recommendation. Use of these agents to reduce fragility fractures in patients with low bone mineral density is beyond the scope of the guideline. Recommendations are not meant to restrict such use of bone-modifying agents in these situations. Additional information at www.asco.org\/breast-cancer-adjuvant-bisphosphonates-guideline , www.asco.org\/guidelineswiki , https:\/\/www.cancercareontario.ca\/guidelines-advice\/types-of-cancer\/breast . <\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.2016.70.7257","type":"journal-article","created":{"date-parts":[[2017,4,5]],"date-time":"2017-04-05T09:51:55Z","timestamp":1491385915000},"page":"2062-2081","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":183,"title":["Use of Adjuvant Bisphosphonates and Other Bone-Modifying Agents in Breast Cancer: A Cancer Care Ontario and American Society of Clinical Oncology Clinical Practice Guideline"],"prefix":"10.1200","volume":"35","author":[{"given":"Sukhbinder","family":"Dhesy-Thind","sequence":"first","affiliation":[{"name":"Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. 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