Would you re-introduce bisphosphonate or denosumab in a bone-only metastatic ER+ breast cancer patient with history of osteonecrosis of the jaw?

The ASCO, ADA, and Maxillofacial surgeon society guidelines on osteonecrosis of the jaw do not directly address this scenario. The antiresorptive effects of bisphosphonates persist for a long time after cessation due to a long half life in the bone. This is not the case with denosumab. Also bisphosp...

Given the modest absolute benefit of 'bone-sparing' therapy in breast cancer patients with bone metastases, and the long duration of healing in patients with even low grade ONJ, I would avoid restarting this treatment, even after switching to a different agent. The only exception would be in patient...