Bisphosphonates are effective for reducing the skeletal complications of metastatic breast cancer. Current treatment guidelines tend to recommend starting bisphosphonates at the time of diagnosis of bone metastases and continuing indefinitely or until the patients' performance status declines substantially. While meta-analyses of clinical trials have suggested that treatment should continue for at least 6 months to reduce skeletal-related events, few data exist on alternative strategies to optimize therapy. Other indications for bisphosphonates in the management of breast cancer include managing reduced bone mineral density in patients with early stage disease. In addition, because of considerable preclinical and clinical evidence that they may have direct antitumor actions, bisphosphonates are being tested as adjuvant therapy for early stage breast cancer in a number of large clinical trials.