Over 80% of women with advanced breast cancer ultimately develop bone metastases which account significantly for morbidity and mortality. Breast cancer metastases in bone can cause intractable pain, bone fracture, spinal cord compression and hypercalcaemia. It also signifies that the malignant process is incurable since, once tumour cells become lodged in the skeleton, therapy can only be given with palliative intent. This includes analgesics, radiation therapy and systemic treatments such as hormone or chemotherapy. The events leading to the development of bone lesions in patients with carcinoma of the breast are poorly understood. However, histomorphometric studies have shown that tumour cells are adjacent to actively resorbing osteoclasts (Boyde et al, 1986) and it has been suggested that breast carcinoma cells possess the capacity to recruit and stimulate osteoclasts by producing stimulatory factors (Boyde et al, 1986). Parathyroid hormone related peptide (PTHrP) is thought to be a major candidate factor produced by breast cancer cells which may promote osteoclastic activity at metastatic sites in bone (Powell et al, 1991).Bisphosphonates (BPs) are analogues of endogenous pyrophosphates in which a carbon atom replaces the central atom of oxygen. In vivo, bisphosphonates bind strongly to hydroxyapatite on the bone surface and are preferentially delivered to sites of increased bone formation or resorption. They are potent inhibitors of osteoclast-mediated bone resorption (Boonecamp et al, 1986) and are effective in lowering serum calcium concentrations in patients with hypercalcaemia of malignancy (Ryzen et al, 1985;Kanis et al, 1987). Bisphosphonates are also used in the treatment of Paget's disease of bone (Altman et al, 1973;Plasmans et al, 1978) and bone lesions associated with multiple myeloma (Berenson et al, 1996). The mechanisms by which bisphosphonates inhibit osteoclast-mediated bone resorption remain to be determined, but may involve inhibition of formation of osteoclasts from immature precursor cells (Boonecamp et al, 1986;Lowik et al, 1988;Hughes et al, 1989) and/or direct inhibition of resorption via induction of apoptosis in mature osteoclasts (Lowik et al, 1988;Hughes et al, 1995;Selander et al, 1996). More recently, several reports have indicated that bisphosphonates have direct effects on other cell types which may have important implications in the treatment of patients with cancer-induced bone disease. Treatment with intravenous pamidronate (Hortobagyi et al, 1998) and oral clodronate (Paterson et al, 1993) have been reported to reduce the frequency of skeletal complications in established bone disease. Oral clodronate has also been shown to decrease the frequency of skeletal metastases in women who had recurrent breast cancer but without bony involvement (Kanis et al, 1996). Moreover, oral clodronate has recently been shown to increase survival in women with breast cancer, when given at the time of initial diagnosis to patients who have bone marrow micrometastases at the time of surgery fo...