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

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.

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

Journal of Oncology Practice ◽

10.1200/jop.2016.018341 ◽

2017 ◽

Vol 13 (5) ◽

pp. e505-e515 ◽

Cited By ~ 3

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.

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Vitamin D deficiency and bone mineral density in postmenopausal women receiving aromatase inhibitors for early breast cancer

Maturitas ◽

10.1016/j.maturitas.2010.03.012 ◽

2010 ◽

Vol 66 (3) ◽

pp. 291-297 ◽

Cited By ~ 35

Author(s):

Xavier Nogues ◽

Sonia Servitja ◽

Maria Jesus Peña ◽

Daniel Prieto-Alhambra ◽

Rosa Nadal ◽

...

Keyword(s):

Breast Cancer ◽

Bone Mineral Density ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Postmenopausal Women ◽

Early Breast Cancer ◽

Bone Mineral ◽

Aromatase Inhibitors ◽

Mineral Density

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Changes in bone mineral density and biochemical markers of bone turnover in postmenopausal women with breast cancer initiating aromatase inhibitors therapy

Bone Abstracts ◽

10.1530/boneabs.3.pp99 ◽

2014 ◽

Author(s):

Maria Luchavova ◽

Martina Zimovjanova ◽

Vit Zikan ◽

Jana Pribylova ◽

Michaela Cabinakova ◽

...

Keyword(s):

Breast Cancer ◽

Bone Mineral Density ◽

Bone Turnover ◽

Postmenopausal Women ◽

Bone Mineral ◽

Aromatase Inhibitors ◽

Biochemical Markers ◽

Mineral Density ◽

Markers Of Bone Turnover

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

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e11604 ◽

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.

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Effect of Endocrine Therapies on Bone in Breast Cancer Patients

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2010-1679 ◽

2011 ◽

Vol 96 (2) ◽

pp. 308-319 ◽

Cited By ~ 43

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.

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AB0901 Bone Mineral Density and Morphometric Vertebral Deformities in Postmenopausal Women Receiving Aromatase Inhibitors for Breast Cancer

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2015-eular.3986 ◽

2015 ◽

Vol 74 (Suppl 2) ◽

pp. 1201.2-1201

Author(s):

L.V. Maldonado-Romero ◽

M. Ahijόn-Lana ◽

C. Velázquez-Arce ◽

W.A. Sifuentes Giraldo ◽

N. Martínez Jañez ◽

...

Keyword(s):

Breast Cancer ◽

Bone Mineral Density ◽

Postmenopausal Women ◽

Bone Mineral ◽

Aromatase Inhibitors ◽

Mineral Density ◽

Vertebral Deformities

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Effect of tamoxifen on bone mineral density measured by dual-energy x-ray absorptiometry in healthy premenopausal and postmenopausal women.

Journal of Clinical Oncology ◽

10.1200/jco.1996.14.1.78 ◽

1996 ◽

Vol 14 (1) ◽

pp. 78-84 ◽

Cited By ~ 450

Author(s):

T J Powles ◽

T Hickish ◽

J A Kanis ◽

A Tidy ◽

S Ashley

Keyword(s):

Breast Cancer ◽

Bone Mineral Density ◽

Lumbar Spine ◽

Postmenopausal Women ◽

Bone Mineral ◽

Premenopausal Women ◽

Dual Energy ◽

Mineral Density ◽

X Ray ◽

The Mean

PURPOSE Tamoxifen is an effective treatment for metastatic and primary breast cancer and is now being evaluated as a chemoprevention agent in healthy women. Any long-term effects on estrogen-sensitive tissues such as bone may have important therapeutic implications. METHODS We measured bone mineral density (BMD) in the lumbar spine and hip using dual-energy x-ray absorptiometry (DXA) in premenopausal and postmenopausal healthy women who participated in our placebo-controlled tamoxifen chemoprevention of breast cancer trial. RESULTS BMD data are now available from 179 women for this analysis. In premenopausal women, BMD decreased progressively in the lumbar spine (P < .001) and in the hip (P < .05) for women on tamoxifen, but not those on placebo. The mean annual loss in lumbar BMD per year over the 3-year study period in tamoxifen-treated compliant women who remained premenopausal throughout the study period was 1.44% (1.88% calculated on an intent-to-treat basis) compared with a small gain of 0.24% per annum for women on placebo (P < .001). Tamoxifen had the opposite effect in postmenopausal women. The mean annual increase in BMD for women on tamoxifen was 1.17% in the spine (P < .005) and 1.71% in the hip (P < .001) compared with a noninsignificant loss for women on placebo. CONCLUSION These results indicate that tamoxifen treatment is associated with a significant loss of BMD in premenopausal women, whereas it prevents bone loss in postmenopausal women. These adverse and beneficial effects of tamoxifen should be considered in the assessment of the therapeutic benefits for both the adjuvant treatment and the chemoprevention of breast cancer.

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Nonassociation of Estrogen Receptor Genotypes with Bone Mineral Density and Estrogen Responsiveness to Hormone Replacement Therapy in Korean Postmenopausal Women

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jcem.82.4.3879 ◽

1997 ◽

Vol 82 (4) ◽

pp. 991-995 ◽

Cited By ~ 65

Author(s):

Ki Ok Han ◽

In Gul Moon ◽

Young Soon Kang ◽

Ho Yeon Chung ◽

Hun Ki Min ◽

...

Keyword(s):

Bone Mineral Density ◽

Estrogen Receptor ◽

Hormone Replacement Therapy ◽

Lumbar Spine ◽

Replacement Therapy ◽

Postmenopausal Women ◽

Gene Locus ◽

Restriction Site ◽

Hormone Replacement ◽

Mineral Density

Abstract Hormone replacement therapy (HRT) prevents bone loss in postmenopausal women, but some women are resistant to therapy. A recently reported case of severe estrogen resistance caused by a germ-line mutation at the estrogen receptor (ER) gene locus suggests the possibility that other variants of the ER gene could be responsible for resistance to HRT and could also be an answer to the heritable components of bone density. Three restriction fragment length polymorphisms (RFLPs) at the ER gene locus, represented as BstUI (or B variant), PvuII, and XbaI, and their relationship to bone mineral density (BMD) and estrogen responsiveness to HRT were examined in 248 healthy postmenopausal women, aged 41–68 yr (mean± sd, 52.0 ± 4.6 yr) in Korea. The BstUI restriction site was not found in Korean women. The distribution of the PvuII and XbaI RFLPs was as follows: PP, 35 (14.1%); Pp, 136 (54.8%); pp, 77 (31.1%); and XX, 18 (7.3%); Xx, 72 (29.0%); and xx, 158 (63.7%), respectively (capital letters signify the absence of and lower case letters signify the presence of the restriction site of each RFLP). There was no significant relation between ER genotypes and z score values of lumbar spine BMD. Also, no significant genotypic differences were found in the change in lumbar spine BMD and those in biochemical markers before and after 1 yr of HRT. These data indicate no significant effects of ER genotypes on BMD and estrogen responsiveness after HRT.

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