AI-related BMD variation in actual practice conditions: A prospective cohort study

Abstract

The aim of the study was to evaluate the progression of bone mineral density (BMD) during 3 years of aromatase inhibitors (AI) therapy in actual practice conditions. This prospective, clinical cohort study of Barcelona-Aromatase induced Bone Loss in Early breast cancer (B-ABLE) assessed BMD changes during 3 years of AI treatment in women with breast cancer. Patients with osteoporosis (T score < −2.5 or T score ≤ −2.0) and a major risk factor and/or prevalent fragility fractures were treated with oral bisphosphonates (BPs). Of 685 women recruited, 179 (26.1%) received BP treatment. By the third year of AI therapy, this group exhibited increased BMD in the lumbar spine (LS; 2.59%) and femoral neck (FN; 2.50%), although the increase was significant only within the first year (LS: 1.99% and FN: 2.04%). Despite BP therapy, however, approximately 15% of these patients lost more than 3% of their baseline bone mass. At 3 years, patients without BP experienced BMD decreases in the LS (−3.10%) and FN (−2.79%). In this group, BMD changes occurred during the first (LS: −1.33% and FN: −1.25%), second (LS: −1.19% and FN: −0.82%), and third (LS: −0.57% and FN: −0.65%) years of AI treatment. Increased BMD (>3%) was observed in just 7.6% and 10.8% of these patients at the LS and FN, respectively. Our data confirm a clinically relevant bone loss associated with AI therapy amongst nonusers of preventative BPs. We further report on the importance of BMD monitoring as well as calcium and 25-hydroxy vitamin D supplementation in these patients.

Bone health evaluation one year after aromatase inhibitors completion

“…Further research is needed to explain why patients previously treated with TAM experienced lower LS BMD recovery than patients receiving AI monotherapy. We hypothesize that the accelerated bone loss during AI treatment in pTAM-AI patients, as previously described in B-ABLE cohort [19], might delay LS BMD recovery. Likewise, we cannot know if this BMD could return to baseline levels at long term.…”

Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO, IMS, and SIOG

“…The increase in C-telopeptide after 24 weeks was significantly less in the treatment group compared with that in the placebo group (35.2±17.5% vs. 109.8±28.6%, p <0.05) [109]. In all of the studies of oral bisphosphonates, patients who did not receive a bisphosphonate experienced substantial BMD loss during AI therapy [111].…”

Efecto de la suplementación con vitamina D en los efectos secundarios musculoesqueléticos relacionados con los inhibidores de la aromatasa para el cáncer de mama: cohorte B-ABLE

“…Rev Osteoporos Metab Miner. 2021;13 (2):66-71 ORIGINALS Previous studies in the B-ABLE cohort, a clinical, prospective, cohort study of women diagnosed with early ER+ breast cancer, and candidates for aromatase inhibitor therapy, showed that low levels of 25-hydroxyvitamin D (25(OH)D) were associated with greater bone mass loss and worsening joint pain [9][10][11] . Similarly, IA-related arthralgia in the B-ABLE cohort was significantly reduced in those patients who achieved serum 25(OH)D concentrations ≥40 ng/ml 11 .…”

“…Its use in women as adjunctive treatment for 2-5 years has been correlated with an increased risk of bone loss and fractures 2,3 . Furthermore, AI administration is associated with the appearance and/or increase of arthralgia -described as joint pain-with an estimated incidence of 55% in a previous study by our group 4 .…”