Network meta-analysis of bisphosphonates in the treatment of bone metastases from breast cancer.

OBJECTIVE

Through a network meta-analysis, this study aimed to systematically evaluate the efficacy and safety of bisphosphonates in reducing skeletal-related events in patients with bone metastases from breast cancer, providing clinical guidance for treatment selection.

MATERIALS AND

METHODS

Randomized controlled trials (RCTs) on bisphosphonate therapy for bone metastases in breast cancer were retrieved from PubMed, Cochrane, and Embase databases from inception to January 2025. Statistical analyses were performed using Stata software.

RESULTS

22 studies involving 14,934 patients were included. The bisphosphonates evaluated were pamidronate, zoledronate, clodronate, and ibandronate. Regarding the reduction of pathological fractures, the efficacy ranking was clodronate > ibandronate > pamidronate > zoledronate. Significant differences were found between clodronate and pamidronate (OR = -1.41, 95% CI: -2.78 to -0.04) and between clodronate and zoledronate (OR = -1.44, 95% CI: -2.85 to -0.04). For hypercalcemia reduction, zoledronate was more effective than clodronate and pamidronate, though differences were not statistically significant (p > 0.05). In terms of safety, ibandronate showed fewer adverse reactions than clodronate and zoledronate, with a significant difference between ibandronate and zoledronate (OR = -1.14, 95% CI: -1.99 to -0.28).

CONCLUSION

Clodronate was most effective in reducing pathological fractures, zoledronate was superior in controlling hypercalcemia, and ibandronate demonstrated the best safety profile. Further clinical studies are warranted to clarify the comparative advantages of each bisphosphonate and support individualized treatment decisions.