Loss In Quality Of Life Research Articles

NOX3-TARGETED THERAPIES FOR INNER EAR PATHOLOGIES.

Inner ear pathologies are associated with major morbidity and loss of life quality in affected patients. In many of these conditions, production of reactive oxygen-species (ROS) is thought to be a key pathological mechanism. While the sources of ROS are complex (including for example mitochondria), there is increasing evidence that activation of NOX enzymes, in particular NOX3, plays a key role. NOX3 is a multi-subunit NADPH oxidase, functionally and structurally closely related to NOX1 and NOX2. In both the vestibular and the cochlear compartments of the inner ear, high levels of NOX3 mRNA are expressed. In NOX3 mutant mice, the vestibular function is perturbed due to a lack of otoconia, while only minor alterations of hearing have been documented. However, there is increasing evidence that activation of NOX3 through drugs, noise and probably also aging, leads to hearing loss. Thus, NOX3 is an interesting target to treat and prevent inner ear pathologies and a few first animal models based on drug - or molecular therapy have been reported. So far however, there are no specific NOX3 inhibitors with a documented penetration into the inner ear. Nevertheless, certain antioxidants and non-specific NOX inhibitors diminish hearing loss in animal models. Development of small molecules inhibitors or molecular strategies against NOX3 could improve specificity and efficiency of redox-targeted treatments. In this review, we will discuss arguments for the involvement of NOX3 in inner ear pathologies and therapeutic approaches to target NOX3 activity.

Personality disorders: a burden in the community, neglected in the clinic?

Article Abstract Because this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text. In this issue of the Journal, the article "Reductions in Quality of Life Associated With Common Mental Disorders: Results From a Nationally Representative Sample" by Penner-Goeke and colleagues examines losses in quality of life (QoL) years associated with common mental and physical disorders in the large (US) sample of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The authors were especially interested in assessing the impact of personality disorders on QoL, since personality disorders have rarely been studied in comparison to other disorders in community populations. The NESARC Wave 2 sample is very large (N = 34,533), thus enabling examination of the impact of many variables on QoL simultaneously.

Osteoporotic distal humeral fractures

The management of comminuted intraarticular distal humeral fractures in the presence of osteoporosis continues to be a significant challenge for the treating orthopaedic surgeon. Not only are the economic and societal costs of osteoporosis-related fractures immense, significant patient loss in quality of life is seen after upper-extremity fractures in this population. There has been substantial advancement in both the surgical treatment and rehabilitation of distal humeral fractures in the last decade, including the refinement of surgical approach, evolution of implant design and implementation, and a significant shift towards total elbow arthroplasty for acute trauma. This study reviews the newest research aimed at understanding the role of surgical fixation as compared with total elbow arthroplasty in the management of these difficult fractures.

Peer Support for Individuals with Mental Health Problems and their Relatives - Background, Concept and Baseline Data

Severe mental illness comes along with cyclic hospital re-admission, heavy losses in quality of life and stigmatization. Therefore a refinement of intervention is still required, for patients themselves and their relatives. In mental health services there is an international trend toward recovery-orientated interventions, like peer support. In Germany this is the first trial to implement peer-support area-wide in a metropolis. This article describes the implementation of the network, the methodology of the research setting and the baseline data of the randomized controlled trial.

Comment prendre en compte les préférences des citoyens dans la décision de rembourser un nouveau traitement

Les décisions en matière de remboursement de soins de santé sont complexes : les critères de décision sont nombreux, variés et parfois difficilement conciliables. Dans un système démocratique, la légitimité des décisions exige que les décideurs politiques tiennent, au moins en partie, compte des préférences des citoyens. L’étude présentée ici vise à mesurer l’importance relative, aux yeux des citoyens belges, des critères utilisés pour évaluer les demandes de remboursement de nouvelles interventions de santé. Une enquête a été réalisée dans le grand public en utilisant la méthode des choix discrets (discrete choice experiments, DCE) pour déterminer le poids relatif des critères de décisions. Les réponses de 4 288 participants du grand public ont été utilisées pour l’analyse. Une analyse de régression logistique multinomiale a été réalisée pour analyser les données. Les résultats montrent que les citoyens estiment que la qualité de vie est le critère qui doit peser le plus sur l’évaluation de la nécessité thérapeutique et sur les décisions de rembourser ou non un nouveau traitement. L’impact sur l’espérance de vie est également un critère important mais il est mis en balance avec la perte de qualité de vie. JEL Classification : D71, D81, I13, I18

Reducing Periconceptional Methylmercury Exposure: Cost-Utility Analysis for a Proposed Screening Program for Women Planning a Pregnancy in Ontario, Canada.

BackgroundThe assessment of neurodevelopmental effects in children associated with prenatal methylmercury exposure, from contaminated fish and seafood in the maternal diet, has recently been strengthened by adjustment for the negative confounding resulting from co-exposure to beneficial polyunsaturated fatty acids (PUFAs).ObjectivesWe aimed to determine the cost-effectiveness of a periconceptional screening program of blood mercury concentration for women planning to become pregnant in Ontario, Canada. Fish intake recommendations would be provided for those found to have blood mercury levels above the intervention threshold.MethodsAnalysis was conducted using a combined decision tree/Markov model to compare the proposed screening intervention with standard care from a societal perspective over a lifetime horizon. We used the national blood mercury distributions of women 20–49 years of age reported in the Canadian Health Measures Survey from 2009 through 2011 to determine the cognitive deficits associated with prenatal methylmercury exposure for successful planned pregnancies. Outcomes modeled included the loss in quality of life and the remedial education costs. Value of information analysis was conducted to assess the underlying uncertainty around the model results and to identify which parameters contribute most to this uncertainty.ResultsThe incremental cost per quality-adjusted life year (QALY) gained for the proposed screening intervention was estimated to be Can$18,051, and the expected value for a willingness to pay of Can$50,000/QALY to be Can$0.61.ConclusionsOur findings suggest that the proposed periconceptional blood mercury screening program for women planning a pregnancy would be highly cost-effective from a societal perspective. The results of a value of information analysis confirm the robustness of the study’s conclusions.CitationGaskin J, Rennie C, Coyle D. 2015. Reducing periconceptional methylmercury exposure: cost–utility analysis for a proposed screening program for women planning a pregnancy in Ontario, Canada. Environ Health Perspect 123:1337–1344; http://dx.doi.org/10.1289/ehp.1409034

Cell Count in Osteoporotic Bone Proves Cell Death as a Cause for the Disruption of Bone Architecture and Cause for the Osteoporotic Disease

Introduction Osteoporosis is a pandemic class disease, it has been up until today the main cause for fractures in the elderly, and perhaps the main cause of disability and loss of life quality in older people. It also represents a cause for the loss of billions of dollars worldwide attending its complications. It has been managed until today performing tests looking for bone density for its diagnosis and treatment, with very poor success rates. The bone cell “osteocyte” is the functional unit of the bone, and even though its function has not been well studied, osteoclasts and osteoblasts have been extensively studied. It is my belief that the cause for this disease has a closer relationship to this cell than to osteoblast–osteoclast activity. We will evaluate the number of osteocytes found in the lacunae of the bone and its relationship with the trabecular patterns. The hypothesis for this study is that osteocyte death decreases the number per square millimeter of its population so bone architecture suffers and this causes bone to be more fragile. Material and Methods A total of eight human live bone samples obtained from patients with low-force fractures, one human live bone sample obtained from an otherwise healthy patient, one manual trocar for sample obtention, one optic microscope, hematoxylin eosin tincture kit, one microtome, and one microcamera. In the operating room, under sterile technic, an orthopedic surgeon takes a bone sample from the calcar region with a manual trocar in low-force fractured patients, the sample is put in formaldehyde solution 10%, then it is taken to the pathology laboratory where the sample is cut, run through hematoxylin eosin tincture process, microtomed, and put in a glass slide, then observed in the optic microscope in ×10, ×60, and ×100 objectives, microphotographs are taken and analyzed by three different observers, a pathologist, an orthopedic surgeon, and an orthopedic resident, cells are counted and results analyzed in a spread sheet to obtain a t test, using Kappa to analyze interobserver differences. Results A total of three subjects were excluded from the study during the trial because of errors during the sample management, six subjects were analyzed obtaining a mean empty lacuna lacunae per square millimeter of 6,400 Pearson correlation test of 0.95, p = 0.05, tT = 1.943, tc = 6.598, lacuna lacunae with cells count of 2,200 cells per square millimeter r = − 0.148, tT = 1.476, tC = 0.299, p = 0.10. Interobserver difference Kappa index of 1. Trabecular patterns were also analyzed observing a loss of parallel pattern in places where no osteocytes are found. Conclusion In the analyzed samples, the number of lacuna lacunae with osteocytes was less than half compared with the lacuna lacunae without osteocyte in its interior; the interobserver rate Kappa 1 demonstrates visual analyses of this information performed through microphotographs. In addition, the architecture of the trabeculae observed in zones where lacuna lacunae are empty is lost, observing trabeculae with irregular patterns; irregularity increases as lacuna lacunae appear empty. These demonstrates that osteoporotic bone becomes fragile not because of the calcic density, but because trabecular organization and architecture depends directly correlational to the number of osteocytes in the region. Bone density and cell population are two different patterns; cell absence in bone is probably the cause of fragile bone because of the trabecular architectural pattern loss.

Association between progressive retinal nerve fiber layer loss and longitudinal change in quality of life in glaucoma.

Evaluation of structural optic nerve damage is a fundamental part of diagnosis and management of glaucoma. However, the relationship between structural measurements and disability associated with the disease is not well characterized. Quantification of this relationship may help validate structural measurements as markers directly relevant to quality of life. To evaluate the relationship between rates of retinal nerve fiber layer (RNFL) loss and longitudinal changes in quality of life in glaucoma. Observational cohort study including 260 eyes of 130 patients with glaucoma followed up for a mean (SD) of 3.5 (0.7) years. All patients had repeatable visual field defects on standard automated perimetry (SAP) at baseline. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was performed annually, and spectral-domain optical coherence tomography and SAP were performed at 6-month intervals. A joint model was used to investigate the association between change in NEI VFQ-25 Rasch-calibrated scores and change in RNFL thickness, adjusting for confounding socioeconomic and clinical variables. Association between change in binocular RNFL thickness (RNFL thickness in the better eye at each point) and change in NEI VFQ-25 scores. Progressive binocular RNFL thickness loss was associated with worsening of NEI VFQ-25 scores over time. In a multivariable model adjusting for baseline disease severity and the rate of change in binocular SAP sensitivity, each 1-μm-per-year loss of RNFL thickness was associated with a decrease of 1.3 units (95% CI, 1.02-1.56) per year in NEI VFQ-25 scores (P < .001). After adjusting for the contribution from SAP, 26% (95% CI, 12%-39%) of the variability of change in NEI VFQ-25 scores was associated uniquely with change in binocular RNFL thickness. The P value remained less than .001 after adjusting for potential confounding factors. Progressive binocular RNFL thickness loss was associated with longitudinal loss in quality of life, even after adjustment for progressive visual field loss. These findings suggest that rates of binocular RNFL change are valid markers for the degree of neural loss in glaucoma with significant relationship to glaucoma-associated disability.

Sedative-hypnotic medicines and falls in community-dwelling older adults: a cost-effectiveness (decision-tree) analysis from a US Medicare perspective.

Both the 2012 Beers list and the American Geriatric Society 'Choosing Wisely' campaign suggest restraint in the use of sedative-hypnotics for the treatment of insomnia in older people. Sedative hypnotic agents continue to be widely prescribed even though their use in the elderly is associated with an increased risk of falls, fractures, and emergency hospitalizations. The aim of this study was to estimate the cost effectiveness of cognitive behavioral therapy (CBT) compared with sedative-hypnotics and no treatment for insomnia in the US Medicare population, adjusting for the risk of falls and related consequences. A model-based economic evaluation (decision tree) using the US Medicare perspective and a conservative annual temporal framework was conducted. Simulations were performed in a hypothetical cohort of Medicare beneficiaries suffering from insomnia. The main outcome measure was the incremental cost per quality-adjusted life year (QALY) gained. Sensitivity analyses assessed the robustness of the base-case analysis. On an annual basis, CBT showed a dominance (cost: US$19,442; QALYs: 0.594) over sedative hypnotics (cost: US$32,452; QALYs: 0.552) and no treatment (cost: US$33,853; QALYs: 0.517). Assuming a willingness to pay of US$50,000, the net monetary benefit was positive for CBT (US$10,287) and negative for sedative hypnotics (-US$4,851) and no treatment (-US$7,993). CBT had a 95% chance of being the dominant strategy, with results most sensitive to an older adult's baseline risk of falling. Failure to consider drug harms such as drug-induced falls and hospitalization represents a growing public health concern, significantly underestimating the cost of sedative-hypnotic therapy and loss in quality of life for the elderly. Public payers should reconsider reimbursement of sedative-hypnotic drugs as first-line treatment for insomnia in older adults.

New Approaches in the Treatment of Osteoarthritis

Degenerative joint disease, also known as osteoarthritis, is currently one of the most prevalent and morbid diseases due to an increase in both life expectancy and obesity. Moreover, due to its severity and irreversibility, osteoarthritis causes a severe social and economic impact around the world due to the loss in quality of life and productivity. Osteoarthritis is known to be a multifactorial disease, where several risk factors have been already described, leading to temporary and progressive structural changes within joint tissues, especially in joint cartilage, subchondral bone, synovial membrane and synovial liquid, causing the main clinical symptoms such as chronic pain, joint instability, stiffness and joint space narrowing. The use of advanced therapies for treating this disease is guided to a regenerative medicine aimed to encourage the regenerative or restorative methods, being a new alternative to more aggressive treatments. Within these treatments we can find platelet-rich plasma (PRP) and mesenchymal stem cells (MSC). PRP is an autologous novel therapeutic tool that has risen strongly in the past few years and has several applications within the medical field. It is defined as a biological product derived from the own patient’s blood, obtaining a plasma fraction after a centrifugation process with a platelet concentration greater than the existing in the circulatory system. Many of the factors contained in the interior of PRP have specific activity of neoproliferation and cartilage regeneration. There are increasing studies regarding MSC and osteoarthritis treatment, especially in relation to MSC derived from adipose tissue. These cells have shown its capacity to differentiate into chondrocytes, osteocytes and adipocytes, as well as their advantage that they can be obtained in bigger quantities with little morbidity to the donor site and reduced discomfort to the patient. It has been confirmed that autologous MSC have great affinity for the injured tissue of the joint, being able of localizing and participating in repair of structures of the injured joint.

Quality of life in rectal cancer surgery: What do the patient ask?

Rectal cancer surgery has dramatically changed with the introduction of the total mesorectal excision (TME), which has demonstrated to significantly reduce the risk of local recurrence. The combination of TME with radiochemotherapy has led to a reduction of local failure to less than 5%. On the other hand, surgery for rectal cancer is also impaired by the potential for a significant loss in quality of life. This is a new challenge surgeons should think about nowadays: If patients live more, they also want to live better. The fight against cancer cannot only be based on survival, recurrence rate and other oncological endpoints. Patients are also asking for a decent quality of life. Rectal cancer is probably a paradigmatic example: Its treatment is often associated with the loss or severe impairment of faecal function, alteration of body anatomy, urogenital problems and, sometimes, intractable pain. The evolution of laparoscopic colorectal surgery in the last decades is an important example, which emphasizes the importance that themes like scar, recovery, pain and quality of life might play for patients. The attention to quality of life from both patients and surgeons led to several surgical innovations in the treatment of rectal cancer: Sphincter saving procedures, reservoir techniques (pouch and coloplasty) to mitigate postoperative faecal disorders, nerve-sparing techniques to reduce the risk for sexual dysfunction. Even more conservative procedures have been proposed alternatively to the abdominal-perineal resection, like the local excisions or transanal endoscopic microsurgery, till the possibility of a wait and see approach in selected cases after radiation therapy.

Osteoarthritis.

Osteoarthritis is nowadays one of the most frequent chronic diseases and, with the increase in life expectancy, both its prevalence and incidence is expected to rise. This condition is progressive and leads to functional decline and loss in quality of life, with important health care and society costs. A review of relevant and recent literature on osteoarthritis was performed in PubMed. The purpose of this study is to understand important aspects about osteoarthritis estimates, burden of disease, pathophysiology, risk factors, diagnosis and treatment.

Improving safety of diabetes mellitus management.

Improving safety of diabetes mellitus management.

Postural control and binocular anomalies

AbstractVergence insufficiency is an extraocular dysfunction screened regularly by ophthalmologists and orthoptists. Incidence increases with screen and computer work, resulting in visual quality and quality of life loss. Clinical diagnosis is based on associated well‐defined criteria (Alvarez 2010, Horwood 2014). Quantification of symptoms reported (Echelle CISS), evaluation of response to disparity stimuli and accommodation in natural spaces, calculation of ratio accommodation/vergence and measure of static performance. These criteria are essentially subjective and break the natural bond of two synergistic systems: convergence and accommodation. In the literature very few studies objectify dysfunction with video‐oculography because most authors induce either angular disparities by artificial haploscopic devices or defocusing. However, restricting the visual examination to each component, the vergence of the one part, and on the other hand accommodation, this analytical fragmentation is not representative of the daily behavior of patients. Indeed, in the natural space simultaneous variations of angles of disparity and focus stimulate and maintain synergy vergence‐accommodation. Therefore, we propose an ecological study of the vergence system by stimulating real space. In the meantime our daily actions seek simultaneously vergence and saccadic eye movements, we also extend the study to the combined movement.

The effects of immunotherapy with intravenous immunoglobulins versus no intervention, placebo, or usual care in patients with recurrent miscarriages: a protocol for a systematic review with meta-analyses, trial sequential analyses, and individual patient data meta-analyses of randomised clinical trials.

BackgroundRecurrent miscarriage is generally defined as three or more miscarriages before gestational week 20. Recurrent miscarriage affects 1% of all women and the condition can only be explained by parental chromosome abnormalities, uterine malformations, or endocrine or thrombophilic disturbances to a limited extent. Immunological disturbances are hypothesised to play an important role in recurrent miscarriage and, therefore, various types of immunologically-based therapies have been tested in recurrent miscarriage patients including intravenous immunoglobulins. So far, at least eight randomised placebo-controlled trials, with opposing results, investigating intravenous immunoglobulins with a total of 324 recurrent miscarriage patients have been published.Methods/DesignWe will include randomised clinical trials irrespective of publication date, publication type, publication language, and publication status investigating infusions with immunoglobulins in relation to pregnancy compared to placebo, no intervention, or treatment as usual for assessments of benefits and harms. The relevant published literature will be searched using the following databases: Cochrane Central Register of Controlled Trials, Medline, Embase, WHO International Clinical Trials Registry Platform, and Ovid Medline In-Process and Other Non-Indexed Citations databases. Two review authors will independently extract data and assess risk of bias. We will undertake meta-analyses according to the recommendations stated in the Cochrane Handbook for Systematic Reviews of Interventions. Further, we will conduct trial sequential analyses and individual patient data meta-analyses.DiscussionA miscarriage results in great sorrow, loss of life quality, and personal concern. In particular, recurrent miscarriage is extremely stressful and burdensome. It is, therefore, very important to conduct research in this area. There is currently no evidence-based treatment for women with recurrent miscarriage which significantly improves their ability to give live birth. Therefore, a comprehensive up-to-date systematic review is needed. By using individual patient data, it will be possible to provide new knowledge about the benefits and harms of intravenous immunoglobulins and try to identify the subgroup in which the treatment will have the highest impact.This systematic review protocol was registered within the International Prospective Register of Systematic Reviews (PROSPERO) as number CRD42014007112.

Research in practice: substance P antagonism in chronic pruritus.

Pruritus is an unpleasant sensation of the skin, which triggers a desire to scratch or rub. The chronic form (≥6 weeks' duration) often occurs as a side effect of many diseases and is usually accompanied by a high loss in quality of life for patients, especially in cases in which the symptom is chronic without adequate treatment options. In recent years, the situation improved continuously, guidelines for chronic pruritus have been defined and standard medications have been proposed. For many reasons, there are still patients who are unable to obtain relief. New therapeutic approaches are therefore urgently needed. Blocking the neuropeptide substance P is a promising strategy; substance P mediates clinically relevant pro-inflammatory effects by binding to the neurokinin 1 receptor (NK-1R). This led us to hypothesize that NK-1R antagonists are promising therapeutic options for chronic pruritus. Several international case series have meanwhile proven the antipruritic effect of the NK-1R antagonist aprepitant for various forms of chronic pruritus. Initiation of clinical trials with new NK-1R-antagonists as a new therapeutic option continues this trend.

Elderly primary care hypertension patients–who to refer for echocardiography?

Heart failure (HF) is a complex clinical syndrome resulting from impaired diastolic and/or systolic function and clinically manifested by numerous, rather unspecific symptoms such as dyspnoea (at rest or exertion), orthopnoea, wheezing, chronic fatigue and lower extremity oedema. The prevalence of HF increases steeply with age, causing high mortality and morbidity, substantial loss in quality of life, and high health care costs [1]. For the diagnosis of HF, guidelines require, in addition to symptoms, objective evidence of cardiac dysfunction that is most commonly assessed by echocardiography. While many conditions may cause HF, the most common aetiologies are coronary artery disease (CAD) and hypertension.

Probability of Osteoporotic Vertebral Fractures Assessment Based on DXA Measurements and Finite Element Simulation

Osteoporotic vertebral fractures represent major cause of disability, loss of quality of life and even mortality among the elderly population. Decisions on drug therapy are based on the assessment of risk factors for fracture, from bone mineral density measurements. The combination of biomechanical models with clinical studies could better estimate bone strength and support the specialists in their decision. A model to assess the probability of fracture, based on the Damage and Fracture Mechanics has been developed, evaluating the mechanical magnitudes involved in the fracture process from clinical bone mineral density measurements. The model is intended for simulating the degenerative process in the skeleton, with the consequent lost of bone mass and hence the decrease of its mechanical resistance which enables the fracture due to different traumatisms. Clinical studies were chosen, both in non-treatment conditions and receiving drug therapy, and fitted to specific patients according their actual bone mineral density measures. The predictive model is applied in a finite element simulation of the lumbar spine. The fracture zone would be determined according loading scenario (fall, impact, accidental loads, etc.), using the mechanical properties of bone obtained from the evolutionary model corresponding to the considered time. Bone mineral density evolution in untreated patients and in those under different treatments was analyzed. Evolutionary curves of fracture probability were obtained from the evolution of mechanical damage. The evolutionary curve of the untreated group of patients presented a marked increase of the fracture probability, while the curves of patients under drug treatment showed variable decreased risks, depending on the therapy type. The finite element model allowed obtaining detailed maps of damage and fracture probability, identifying high-risk local zones at vertebral body, which are the usual localization of osteoporotic vertebral fractures. The developed model is suitable for being used in individualized cases. The model might better identify at-risk individuals in early stages of osteoporosis and might be helpful for treatment decisions.

Understanding the Clinical Results From Contemporary Stereotactic Radiation Therapy

Results: In 140 patients treated with SABR, nervous system diseases accounted for 44%, primary lung cancer for 24%, pulmonary metastases for 11%, bone metastases for 15%, and others for 6%. In nervous system diseases, benign diseases accounted for 23%, primary intracranial meningiomas for 24%, brain metastases for 53%. Acoustic neuroma was seen in patients with skull base and intracranial benign diseases (64%, 9 of 14). A total of 37 lesions were found in 32 patients with brain metastases. There were 34 lesions in 33 primary lung cancer patients and there were 17 pulmonary metastases in 15 patients with primary extra-pulmonary tumor. The median survival time for patients was not achieved. Treated diseases, hypofractionated patterns, follow-up, selected adverse effects and efficacies are shown in the Table. Conclusions: Stereotactic ablative radiation therapy (SABR) had a good local control for relatively isolated lesions. The toxicities were low and hypofractionated doses did not result in a loss in quality of life. SABR ameliorated local tumor control and needed to be further study for longterm outcomes in these entities. Author Disclosure: J. Wang: None. T. Xia: None. L. Ma: None. B. Qu: None. L. Pan: None. G. Zhou: None. Z. Ju: None. C. Xie: None. Y. Guo: None.

Adjuvant bisphosphonates in breast cancer: has the time come?

SUMMARY Bone metabolism is highly affected by changes in ovarian function, which is a common consequence of the treatment of breast cancer patients. Osteopenia and osteoporosis increase the risk of fractures, which are associated with profound loss in quality of life. Bisphosphonates are used with the objective of preventing bone loss in patients with osteoporosis, but data suggest that agents such as zoledronic acid might play a role in the prevention of metastatic disease and therefore have been evaluated in numerous randomized trials in the adjuvant setting. This review article will discuss and analyze the available data regarding the use of bisphosphonates in the adjuvant setting for breast cancer patients. It will focus on the use of bisphosphonates as anticancer agents, but will also discuss the use of these agents for the prevention of bone loss.