From Theory to Practice: Bone Health in Women with Early Breast Cancer Treated with Aromatase Inhibitors

Abstract

Aromatase inhibitors (AI) are extensively used as adjuvant endocrine therapy in post-menopausal women with hormone receptor-positive early breast cancer (HR+ EBC), but their impact on bone health is not negligible. This work aimed to assess bone loss, fracture incidence, and risk factors associated with these events, as well as the prognostic influence of fractures. We have conducted a retrospective cohort study of women with HR+ EBC under adjuvant therapy with AI, during a 3-year period. Four-hundred-and-fifty-one eligible women were reviewed (median age 68 years). Median time under AI was 40 months. A fracture event occurred in 8.4%, mostly in the radium and femoral neck and in older women (mean 74 vs. 68 years, p = 0.006). Age (OR 1.01, 95% CI 1.01–1.07, p = 0.024) and time under AI (OR 1.02, 95% CI 1.00–1.04, p = 0.037) were independent predictors of fracture, with a fair discrimination (AUC 0.71). Analysis of disease-free survival according to fracture event varied between groups, disfavoring the fracture cohort (at 73 months, survival 78.6%, 95% CI, 47.6–92.4 vs. 95.6%, 95% CI, 91.2–97.8, p = 0.027). The multivariate model confirmed the prognostic impact of fracture occurrence (adjusted HR of 3.17, 95% CI 1.10–9.11; p = 0.032). Bone health is often forgotten, despite its great impact in survivorship. Our results validate the pathophysiologic link between EBC and bone metabolism, which translates into EBC recurrence. Further research in this area may help refine these findings. Moreover, early identification of women at higher risk for fractures is warranted.

Vitamin D Deficiency in Women with Breast Cancer: A Correlation with Osteoporosis? A Machine Learning Approach with Multiple Factor Analysis

“…This specific condition is currently defined as cancer treatment-induced bone loss (CTIBL) and might be related to the hormone therapy that negatively affects bone mineral density (BMD) due to the reduction of residual serum endogenous estrogenic levels [5,8,[10][11][12]. Moreover, chemotherapy has been related to an unspecific increase in bone resorption and a higher risk of fragility fractures [13][14][15]. Therefore, specific treatments preventing bone loss and reducing the risk of fragility fractures are strongly recommended to improve the long-term outcomes and management of BC patients [5,16].…”

Effectiveness of intervention for aromatase inhibitor-associated musculoskeletal symptoms

“…Leonor et al found that time under AIs is an independent risk factor for joint pain and bone loss, with reduced disease-free survivalin patients. [ 4 ] In the IBIS-II prevention trial, patients who took anastrozole for 5 years had a significant decrease in bone mineral density. [ 5 ] Nearly 10% of breast cancer patients discontinued AIs due to aromatase inhibitor-associated musculoskeletal symptoms (AIMSS).…”

“…Despite its benefits in breast cancer treatment, its musculoskeletal impact cannot be ignored. Leonor et al found that time under AIs is an independent risk factor for joint pain and bone loss, with reduced disease-free survivalin patients [4] . In the IBIS-II prevention trial, patients who took anastrozole for 5 years had a significant decrease in bone mineral density [5] .…”