Management of Bone Metastases from Breast Cancer Bone metastases occur in 60-80% of advanced breast cancers. Bone related events include: bone pain, fractures, and spinal cord compression. Zoledronic acid has been shown in previous studies to reduce the risk of complications from breast cancer bone metastases, based on the rationale that zoledronic acid inhibits osteoclast-mediated bone resorption. Denosumab (XGEVA) is a subcutaneously injected monoclonal antibody to XGEVA that binds to RANKL, a membrane-penetrating or soluble protein that is essential for osteoclast formation, function and survival. In solid tumors with bone metastases, osteoclast activity is stimulated by RANKL, and XGEVA prevents RANKL activation, preventing bone marrow-associated events by this principle. In a recent randomized controlled study, XGEVA was shown to be more effective in reducing bone marrow-related events compared to zoledronic acid. both XGEVA and zoledronic acid can cause hypocalcemia and care should be taken to supplement calcium and vitamin D. The incidence of osteonecrosis of the jaw in patients treated with XGEVA and zoledronic acid was 0.5%-1%. Therefore, while taking these drugs, care should be taken to maintain oral hygiene and avoid dental-related procedures as much as possible. Management of brain metastases from advanced breast cancer As the survival of breast cancer patients increases significantly, so does the probability of developing brain metastases, which is higher in HER-2 positive breast cancer than in HER-2 negative breast cancer because most chemotherapeutic agents, such as trastuzumab, do not cross the blood-brain barrier. The presence of brain metastases in breast cancer patients is mostly indicative of a poor prognosis. For patients with multiple brain metastases, whole brain radiotherapy is the standard of care. For patients with solitary brain metastases or oligometastatic disease, tumor reduction surgery or stereotactic radiotherapy may be considered. Some patients with brain metastases from breast cancer can also achieve good results after treatment.