However, osteoclastogenesis is not critical for osteoblastic cancer proliferation, such as in the case of prostate cancer.33 Osteoclast inhibitors such as bisphosphonates and denosumab are commonly prescribed for patients with breast cancer metastases to bone.24,34 Although bisphosphonates have been shown to reduce the number of skeletal metastases that develop, they do not consistently prevent pathologic fracture.35,36 Denosumab, a monoclonal antibody targeting RANKL, is plagued by the same issues, in addition to being less cost-effective. This evidence concerns the gene TNFSF11 and breast cancer.