骨调节剂(BMA)目前主要包括双膦酸盐(BP)和地舒单抗，可减少乳腺癌肿瘤骨转移引起的骨相关事件。Journal of Clinical Oncology于2022年1月在线刊发了2022版《双磷酸盐和其他骨调节剂在乳腺癌辅助治疗中的应用：ASCO-OH(CCO)指南更新》。新版指南提示应与所有有指征接受术后辅助治疗的绝经后早期乳腺癌病人，讨论BP辅助治疗。唑来膦酸、氯膦酸盐、伊班膦酸均为推荐药物，建议BP持续时长为2~3年。ABCSG-18与D-CARE研究的结果不一致，且缺乏直接比较地舒单抗与BP作为早期乳腺癌辅助治疗的研究数据，因此不建议使用地舒单抗用于辅助治疗。总之，BP在早期乳腺癌辅助治疗中的地位被进一步肯定，而地舒单抗的价值仍未明确。

Bone-modifying agents (BMAs), including bisphosphonate (BP) and denosumab, can reduce bone-related events caused by breast cancer bone metastasis. “Use of Adjuvant Bisphosphonates and Other Bone-Modifying Agents in Breast Cancer: ASCO-OH (CCO) Guideline Update” was published in Journal of Clinical Oncology in January 2022. The new “2022 version Guideline” suggested that the use of BP should be discussed for all postmenopausal patients with early breast cancer who are indicated for adjuvant therapy. Recommended drugs included zoledronate, clodronate, and ibandronate, and the recommended duration of BP was 2-3 years. Owing to the inconsistent results of the ABCSG-18 and D-CARE trials and the lack of data directly comparing denosumab with BP in early breast cancer, the use of denosumab in adjuvant therapy was not recommended. In conclusion, the role of BP in the adjuvant treatment of early breast cancer has been further affirmed, while the value of denosumab remains unclear.