The American Society of Clinical Oncology and Cancer Care Ontario have updated their guideline on the role of bone-modifying agents (BMAs) in patients with metastatic breast cancer. Among the recommendations:

• Treat patients with breast cancer who have evidence of bone metastases with BMAs.
• Options include denosumab, 120 mg subcutaneously, every 4 weeks; pamidronate, 90 mg intravenously, every 3 to 4 weeks; or zoledronic acid, 4 mg intravenously every 12 weeks or every 3 to 4 weeks.
• Do not use BMAs alone for bone pain, since their analgesic effects are modest.
• Apply the current standard of care for supportive care and pain management: analgesia, adjunct therapies, radiotherapy, surgery, systemic anticancer therapy, and referral to supportive care and pain management.
• Evidence is insufficient to support the use of one BMA over another.