scholarly journals Effect of Endocrine Therapies on Bone in Breast Cancer Patients

2011 ◽  
Vol 96 (2) ◽  
pp. 308-319 ◽  
Author(s):  
R. J. Santen
Keyword(s):  
Breast Cancer ◽  
Bone Mineral Density ◽  
Estrogen Receptor ◽  
Bone Density ◽  
Bone Loss ◽  
Bone Formation ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Mineral Density ◽  
Markers Of Bone Formation

abstract Context: Two common strategies are used to treat estrogen receptor-positive breast cancer in women: tamoxifen to inhibit estrogen action, and aromatase inhibitors (AIs) to block estrogen biosynthesis. Recent data suggest that AIs are more effective than tamoxifen in the adjuvant and advanced disease settings and are now being more commonly used. Tamoxifen, as a selective estrogen receptor modulator, exerts estrogenic effects to preserve bone, whereas the AIs profoundly lower estrogen levels and cause bone loss. Recent comparative studies of these agents provide extensive data on fracture rates, bone mineral density, and markers of bone formation and resorption. Objective: The aim of the study was to review the mechanistic effects of estrogen on bone and clinical data regarding bone density, bone turnover markers, and fracture rates in women with breast cancer taking tamoxifen or AIs. Evidence Acquisition and Synthesis: Data presented reflect a review of the literature and data integration from the perspective of the author's knowledge of the field. Results: Tamoxifen increases bone density and reduces fractures in postmenopausal women with breast cancer, whereas AIs increase rate of fracture, accelerate loss of bone mineral density, and enhance levels of markers of bone formation and resorption. Bisphosphonates and denosumab counteract the effects of the AIs on bone. Guidelines for management of AI-induced bone loss are available from several sources, but a simple algorithm guides decision making most effectively. Conclusions: Endocrine therapy for postmenopausal women with breast cancer exerts substantial effects on bone, and guidelines are available to assist in the management of bone-related problems.

scholarly journals Effect of Endocrine Therapies on Bone in Breast Cancer Patients

Endocrinology ◽  
2011 ◽  
Vol 152 (1) ◽  
pp. 332-332
Author(s):  
R. J. Santen
Keyword(s):  
Breast Cancer ◽  
Bone Mineral Density ◽  
Bone Density ◽  
Bone Loss ◽  
Bone Formation ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Breast Cancer Patients ◽  
Mineral Density ◽  
Markers Of Bone Formation

Recent data suggest that AIs are more effective than tamoxifen in the adjuvant and advanced disease settings and are now being more commonly used. Tamoxifen, as a selective estrogen receptor modulator, exerts estrogenic effects to preserve bone, whereas the AIs profoundly lower estrogen levels and cause bone loss. Recent comparative studies of these agents provide extensive data on fracture rates, bone mineral density, and markers of bone formation and resorption. Objective: The aim of the study was to review the mechanistic effects of estrogen on bone and clinical data regarding bone density, bone turnover markers, and fracture rates in women with breast cancer taking tamoxifen or AIs. Evidence Acquisition and Synthesis: Data presented reflect a review of the literature and data integration from the perspective of the author’s knowledge of the field. Results: Tamoxifen increases bone density and reduces fractures in postmenopausal women with breast cancer, whereas AIs increase rate of fracture, accelerate loss of bone mineral density, and enhance levels of markers of bone formation and resorption. Bisphosphonates and denosumab counteract the effects of the AIs on bone. Guidelines for management of AI-induced bone loss are available from several sources, but a simple algorithm guides decision making most effectively. Conclusions: Endocrine therapy for postmenopausal women with breast cancer exerts substantial effects on bone, and guidelines are available to assist in the management of bone-related problems.

The effect of anastrozole on bone mineral density during the first 5 years of adjuvant treatment in postmenopausal women with early breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11604-e11604
Author(s):  
Hiroaki Inoue ◽  
Akira Hirano ◽  
Kaoru Ogura ◽  
Akinori Hattori ◽  
Mari Kamimura ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Bone Loss ◽  
Adjuvant Therapy ◽  
Femoral Neck ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Mineral Density ◽  
Alendronate Treatment

e11604 Background: Adjuvant therapy with aromatase inhibitors (AI) is associated with increased bone loss in postmenopausal women. We assessed changes in bone mineral density (BMD) from baseline to 60 months of treatment in patients receiving anastrozole (ANA) as initial adjuvant therapy with/without oral bisphosphonates (Bis). Methods: Postmenopausal women with endocrine responsive breast cancer receiving ANA as adjuvant therapy at our hospital since 2004 were enrolled in this study. BMD was assessed by dual-energy X-ray absorptiometry at baseline and after 6, 12, 24, 36, 48 and 60 months. Oral Bis (risedronate or alendronate) treatment was initiated when patients were diagnosed as having osteoporosis with a T-score of -2.5 or lower. Results: Fifty-seven patients were enrolled in the study between 2004 and 2011. Patients’ median age was 65 years (range 50~85) and the median follow-up period was 46.3 months (9.6~83.8). Thirty-five patients were administered Bis (risedronate in 27 patients, alendronate in 8 patients). Within 6 months of hormone therapy, BMD decreased by 0.3% from baseline at the lumbar spine and BMD decreased by 1.2% at the femoral neck. However, BMD increased by 2.8% at the lumbar spine and BMD decreased 0.5% at the femoral neck for 60 months of treatment. In patients treated with upfront Bis (n=24), 4.9% BMD increase from baseline was noted at the lumbar spine whereas in those without Bis (n=20) BMD decreased by 4.6% from baseline within 24 months (p=0.0002). Fractures were observed in 4 patients (7.0%), and 1 patient (1.8%) had fragility fracture. Conclusions: Oral Bis prevented ANA-induced bone loss, and upfront treatment of Bis significantly increased BMD at the lumber spine.

scholarly journals Effect of Adjuvant (Hormonal) Therapy on Bone Mineral Density in Caucasian Women with Breast Cancer

2017 ◽  
Vol 13 (18) ◽  
pp. 1
Author(s):  
Nana Khachidze ◽  
Elene Giorgadze ◽  
Marina Tsagareli ◽  
Nino Dolidze ◽  
Tea Sulikashvvili
Keyword(s):  
Breast Cancer ◽  
Bone Mineral Density ◽  
Estrogen Receptor ◽  
Lumbar Spine ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Aromatase Inhibitors ◽  
Menstrual Period ◽  
Mineral Density ◽  
Caucasian Women

Background and Aim: Aromatase inhibitors (AIs) and selective estrogen receptor modulators (SERMs) are important components of adjuvant endocrine therapy in postmenopausal women with estrogen receptor positive breast cancer. The aim of our study was to assess the effect of AIs and SERMs on bone mineral density (BMD) in Caucasian postmenopausal women with breast cancer. Patients and Methods: 118 postmenopausal Caucasian women were enrolled in the study. 60 patients were receiving AIs and 58 patients – SERMs-Tamoxifen. Patients were also divided into two sub groups: 1) patients with more than 3 years of last menstrual period (LMP) and 2) patients with less than 3 years of last menstrual period. Results: Among Aromatase inhibitors treated patients, there was a decrease in median BMD from baseline to 5 years in lumbar spine and total hip compared with the Tamoxifen group. No patients with normal BMD at baseline became osteoporotic at 5 years. Conclusion: Aromatase inhibitors are associated with accelerated bone loss over the 5-year treatment period. In postmenopausal women, treatment with tamoxifen is associated with preservation of the bone mineral density of the lumbar spine.

Impaired Estrogen Sensitivity in Bone by Inhibiting Both Estrogen Receptor a and b Pathways*

2020 ◽  
Author(s):  
Lungwani Muungo
Keyword(s):  
Bone Mineral Density ◽  
Estrogen Receptor ◽  
Bone Loss ◽  
Bone Turnover ◽  
Bone Mineral ◽  
Female Rats ◽  
Wild Type ◽  
Mineral Density ◽  
Transgenic Rats ◽  
Estrogen Sensitivity

Although it is well established that estrogen deficiencycauses osteoporosis among the postmenopausalwomen, the involvement of estrogen receptor (ER) in itspathogenesis still remains uncertain. In the presentstudy, we have generated rats harboring a dominantnegative ERa, which inhibits the actions of not only ERabut also recently identified ERb. Contrary to our expectation,the bone mineral density (BMD) of the resultingtransgenic female rats was maintained at the same levelwith that of the wild-type littermates when sham-operated.In addition, ovariectomy-induced bone loss wasobserved almost equally in both groups. Strikingly, however,the BMD of the transgenic female rats, after ovariectomized,remained decreased even if 17b-estradiol(E2) was administrated, whereas, in contrast, the decreaseof littermate BMD was completely prevented byE2. Moreover, bone histomorphometrical analysis ofovariectomized transgenic rats revealed that the higherrates of bone turnover still remained after treatmentwith E2. These results demonstrate that the preventionfrom the ovariectomy-induced bone loss by estrogen ismediated by ER pathways and that the maintenanceof BMD before ovariectomy might be compensatedby other mechanisms distinct from ERa and ERbpathways.

scholarly journals Relationship of Bone mineral density and the risk of breast cancer in Korean postmenopausal women

2006 ◽  
Vol 9 (4) ◽  
pp. 330 ◽  
Author(s):  
Hee Jeong Kim ◽  
Jung man Nam-Gung ◽  
Jung Min Koh ◽  
Jung sun Lee ◽  
Soo jeong Hong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Mineral Density ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Mineral Density ◽  
Relationship Of

Bone mineral density and risk of breast cancer in postmenopausal women

2013 ◽  
Vol 138 (1) ◽  
pp. 261-271 ◽  
Author(s):  
Xinhua Qu ◽  
Xiaoyu Zhang ◽  
An Qin ◽  
Guangwang Liu ◽  
Zanjing Zhai ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Mineral Density ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Mineral Density

Ovarian Failure After Adjuvant Chemotherapy Is Associated With Rapid Bone Loss in Women With Early-Stage Breast Cancer

2001 ◽  
Vol 19 (14) ◽  
pp. 3306-3311 ◽  
Author(s):  
Charles L. Shapiro ◽  
Judith Manola ◽  
Meryl Leboff
Keyword(s):  
Breast Cancer ◽  
Bone Mineral Density ◽  
Alkaline Phosphatase ◽  
Adjuvant Chemotherapy ◽  
Bone Loss ◽  
Bone Mineral ◽  
Ovarian Failure ◽  
Mineral Density ◽  
Specific Alkaline Phosphatase ◽  
Bone Specific Alkaline Phosphatase

PURPOSE: We sought to evaluate the effects of chemotherapy-induced ovarian failure on bone loss and markers of skeletal turnover in a prospective longitudinal study of young women with breast cancer receiving adjuvant chemotherapy. PATIENTS AND METHODS: Forty-nine premenopausal women with stage I/II breast cancers receiving adjuvant chemotherapy were evaluated within 4 weeks of starting chemotherapy (baseline), and 6 and 12 months after starting chemotherapy with dual-energy absorptiometry and markers of skeletal turnover osteocalcin and bone-specific alkaline phosphatase. Chemotherapy-induced ovarian failure was defined as a negative pregnancy test, greater than 3 months of amenorrhea, and a follicle-stimulating hormone ≥ 30 MIU/mL at the 12-month evaluation. RESULTS: Among the 35 women who were defined as having ovarian failure, highly significant bone loss was observed in the lumbar spine by 6 months and increased further at 12 months. The median percentage decrease of bone mineral density in the spine from 0 to 6 months and 6 to 12 months was −4.0 (range, −10.4 to +1.0; P = .0001) and −3.7 (range, −10.1 to 9.2; P = .0001), respectively. In contrast, there were no significant decreases in bone mineral density in the 14 patients who retained ovarian function. Serum osteocalcin and bone specific alkaline phosphatase, markers of skeletal turnover, increased significantly in the women who developed ovarian failure. CONCLUSION: Chemotherapy-induced ovarian failure causes rapid and highly significant bone loss in the spine. This may have implications for long-term breast cancer survivors who may be at higher risk for osteopenia, and subsequently osteoporosis. Women with breast cancer who develop chemotherapy-induced ovarian failure should have their bone density monitored and treatments to attenuate bone loss should be evaluated.

The state of bone mineral density in the prolapse of the pelvic organs

GYNECOLOGY ◽  
2021 ◽  
Vol 23 (2) ◽  
pp. 173-176
Author(s):  
Il’nur I. Musin ◽  
Timur B. Minasov ◽  
Raisa A. Naftulovich ◽  
Elena M. Popova ◽  
Karina N. Mingareeva ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Density ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Roc Analysis ◽  
Genital Prolapse ◽  
Outpatient Basis ◽  
Mineral Density ◽  
Severe Osteoporosis ◽  
Experimental Group

Background. Plausible predictions of future mortality and disability are useful aids in making decisions about priorities for medical research. Recent advances in medicine have led to the fact that some countries, such as Japan, have the highest life expectancy in the world. Osteoporotic fractures make a significant contribution to the development of morbidity and mortality in the aging population. Despite an active study of the mechanisms of the development of pelvic organ prolapse and disorders of bone mineral density separately, the general background of these diseases has previously been little studied. Aim. To study bone density according to densitometry data in peri- and postmenopausal women. Materials and methods. To carry out this study, 2 groups of women were formed. The first (experimental) group included 76 women admitted for routine surgical treatment of genital prolapse, the second group (control) 68 women without clinical manifestations of pelvic floor descent, who underwent a medical examination by a gynecologist on an outpatient basis. Results. Analysis of extragenital diseases in women included in the study showed a high prevalence in the experimental group of hypertension (p=0.028), osteochondrosis (p=0.001), scoliosis (p=0.028), hemorrhoids (p=0.013). Also, women in this group more often noted stretch marks on the skin (p=0.002) and were more often operated on for other diseases (p=0.043), which indicates the association of genital prolapse with undifferentiated connective tissue dysplasia and hypertension. The diagnosed severe osteoporosis (according to 1 or more densitometry indicators, where the T-score is less than -2.5) had a direct correlation with the duration of menopause. For a detailed analysis of the factors influencing severe osteoporosis in peri- and postmenopausal women, logistic regression analysis and ROC analysis were performed. The independent variable was the presence of severe osteoporosis, and the dependent variables were: stage according to POP-Q, the presence of hypertension, the presence of diabetes mellitus in history. Conclusion. This study confirms the presence of a comorbidity decrease in bone density according to densitometry and the presence of hypertension (p=0.028) and genital prolapse. According to the ROC analysis, an increase in the stage of genital prolapse according to the POP-Q classification increases the risk of developing severe osteoporosis.

scholarly journals Bone Density Screening in Postmenopausal Women With Early-Stage Breast Cancer Treated With Aromatase Inhibitors

2017 ◽  
Vol 13 (5) ◽  
pp. e505-e515 ◽  
Author(s):  
Jamie Stratton ◽  
Xin Hu ◽  
Pamela R. Soulos ◽  
Amy J. Davidoff ◽  
Lajos Pusztai ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Mineral Density ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Aromatase Inhibitors ◽  
Early Stage ◽  
Mineral Density ◽  
Dxa Scan ◽  
Bone Mineral Density Testing

Purpose: In postmenopausal women with breast cancer treated with aromatase inhibitors (AIs), most expert panels advise baseline bone mineral density testing with a dual-energy x-ray absorptiometry (DXA) scan repeated every 1 to 2 years. How often this recommendation is followed is unclear. Methods: We performed a retrospective analysis of women with stage I to III breast cancer who started AI therapy from January 1, 2008, to December 31, 2010, with follow-up through December 31, 2012, by using the SEER-Medicare database. Selection criteria included AI use for ≥ 6 months and no recent osteoporosis diagnosis or bisphosphonate use. We used multivariable logistic regression to investigate associations between patient characteristics and receipt of a baseline DXA scan. In patients who continued AI treatment, we assessed rates of follow-up scans. Results: In the sample of 2,409 patients (median age, 74 years), 51.0% received a baseline DXA scan. Demographic characteristics associated with the absence of a baseline DXA scan were older age (85 to 94 years v 67 to 69 years; odds ratio [OR], 0.62; 95% CI, 0.42 to 0.92) and black v white race (OR, 0.68; 95% CI, 0.47 to 0.97). Among patients who underwent a baseline DXA scan and continued AI for 3 years, 28.0% had a repeat DXA scan within 2 years and 65.9% within 3 years. In aggregate, of the 1,164 patients who continued with AI treatment for 3 years, only 34.5% had both a baseline and at least one DXA scan during the 3-year follow-up period. Conclusion: The majority of older Medicare beneficiaries with breast cancer treated with AIs do not undergo appropriate bone mineral density evaluation.

scholarly journals Effect of BMI(Body Mass Index) on BMD (Bone Mineral Density) in Postmenopausal Women

2020 ◽  
Vol 28 (1) ◽  
pp. 60-66
Author(s):  
Tabassum Ghani ◽  
Subinoy Krishna Paul ◽  
Afrina Begum ◽  
Noorjahan ◽  
Mandira Sarkar ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Body Mass Index ◽  
Bone Loss ◽  
Postmenopausal Women ◽  
Body Mass ◽  
Bone Mineral ◽  
Significant Positive Correlation ◽  
Mineral Density ◽  
Positive Correlation ◽  
Medical College

Menopause is commonly associated with rapid bone loss and this bone loss manifests as a significant decrease in bone mineral density (BMD). Body weight or body mass index is the most important factor which influences BMD. Aim of this study was to evaluate the association between BMI and BMD in post menopausal women. Also to measure the correlation between age, duration of menopause, weight with BMD. This cross-sectional study was undertaken in the Department of Obstetrics and Gynaecology in Dhaka Medical College Hospital, Dhaka from January, 2012 to December, 2012. The study included women of 50 to 70 years who had menopause with three or more parity. Total 100 women were evaluated by history taking, physical examination and laboratory investigation (BMD).The results showed that there was significant positive correlation between BMI and BMD value of L1-4 and total femur (Pearson‘s coefficient was +0.285, P<0.01 and +.350, P<.001). There was also significant positive correlation between weight and T- score of L1-4 (r =+ .482, P<.01) and Total femur (r = +.513, P< .01). In addition, significant negative correlation was found between BMD with age and duration of menopause. It can be concluded that in postmenopausal women as the BMI decreases bone mineral density also decreases. So, adequate weight and BMI necessary for the prevention of osteoporosis. J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 60-66

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