|4 to 12-weekly IV zoledronic acid
OR 4 to 12-weekly subcutaneous denosumab
|As long as clinically appropriate|
|Early breast cancer
||6-weekly IV zoledronic acid for 3 cycles followed by
EITHER daily oral ibandronate
OR 6-monthly IV zoledronic acid
|Up to 3 years|
| Early breast cancer
||Daily oral ibandronate OR 6-monthly IV zoledronic acid||Up to 3 years|
|Multiple myeloma||4-weekly IV zoledronic acid
OR daily oral sodium clodronate
See Guideline: Bisphosphonate Use in Myeloma Patients
| Prostate cancer
||3 to 4-weekly IV zoledronic acid||As long as clinically appropriate|
| Lung cancer
||3 to 4-weekly IV zoledronic acid||Concurrently with first-line systemic anticancer treatment, stopped at the end of course; repeated during second-line treatment if required|
||3 to 4-weekly IV zoledronic acid||As long as clinically appropriate
(Note increased risk of osteonecrosis of the jaw with concurrent tyrosine kinase inhibitors)
Other solid tumour*
|IV zoledronic acid may be considered a treatment option where there is evidence to do so||As long as clinically appropriate|
NB: Onset of treatment effect of zoledronic acid may be 2 to 3 months from initiation of therapy.
† Adjuvant bisphosphonates are only recommended for use in women who are postmenopausal, unless the adjuvant/neoadjuvant treatment plan includes ovarian suppression therapy (i.e. GnRH agonist) or oophorectomy. Consultant decision.
*Non-formulary approval will be required.