In what situations would you consider starting zoledronic acid in an adjuvant setting for a woman with T2N0 hormone positive breast cancer?

Adjuvant bisphosphonates should be considered in older, postmenopausal women or in younger, premenopausal women who are on ovarian suppression. I would check a baseline DEXA scan in this particular woman, and if she has osteopenia or osteoporosis, I would start her on a bisphosphonate. She would be on aromatase inhibitors anyway that may further contribute to bone loss. If she has normal DEXA scan, I would discuss the findings of the meta-analysis presented by Professor Coleman at the San Antonio Breast Cancer Symposium 2013 that suggests a beneficial effect for adjuvant bisphosphonates in decreasing the risk for new bone metastases and breast cancer-related mortality. If she is willing to accept the small risk for osteonecrosis of the jaw ...