Bone loss during neoadjuvant/adjuvant chemotherapy for�early stage breast cancer: A retrospective cohort study

Abstract

The present study aimed to evaluate the extent of loss in bone mineral density (BMD) during neoadjuvant and adjuvant chemotherapy for early stage breast cancer. A retrospective cohort study was conducted to quantify the loss of BMD one year following the start of chemotherapy and to identify potential risk factors of excessive BMD loss. Based on DXA-scans prior to and one year following chemotherapy, the loss of BMD was evaluated in early stage breast cancer patients treated from January 2012 to December 2014. A total of 492 patients received either eight cycles of neoadjuvant or six cycles of adjuvant chemotherapy. The final analysis included 152 patients with two DXA-scans. The patients had a significant loss of BMD in the hip [-0.0124 g/cm (95% confidence interval (CI) -0.018; -0.007) P<0.001] and in the lumbar spine [-0.029 g/cm (95% CI: -0.036; -0.023) P<0.001] corresponding to a change of -1, 3 and -2, 9%, respectively. Premenopausal women had a significant loss of BMD in the lumbar spine -0.045 g/cm equivalent to -4.3%, which was significantly increased compared with postmenopausal women (P<0.001) in the univariate analysis, whereas only a trend persisted in the multivariate analysis (P=0.60). There was no significant difference in BMD loss (lumbar spine P=0.176) between patients receiving adjuvant and neoadjuvant chemotherapy. In conclusion, neoadjuvant and adjuvant chemotherapy is associated with significant BMD loss in both hip and lumbar spine. Furthermore, the results of the present study indicate that premenopausal women have a pronounced BMD loss in the lumbar spine. Further studies investigating osteoporosis prophylaxis in premenopausal patients are warranted.

The impact of metformin use on the outcomes of locally advanced breast cancer patients receiving neoadjuvant chemotherapy: an open-labelled randomized controlled trial

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Standardized Uptake Value from Semiquantitative Bone Single-Photon Emission Computed Tomography/Computed Tomography in Normal Thoracic and Lumbar Vertebrae of Breast Cancer Patients

“…This increase of bone density has been suggested to be a result of the rise in physical burden due to the high center of gravity [ 8 ]. In a study by Axelsen et al [ 24 ], it was concluded that chemotherapy in breast cancer patients results in a significant bone mineral densitometry (BMD) loss due to an increase in bone turnover, leading to osteoporosis. Furthermore, Huang et al [ 25 ] also found that both the SUV mean and SUV max in osteoporotic patients are significantly lower compared with those in non-osteoporotic patients.…”

Zoledronic Acid Improves Muscle Function in Healthy Mice Treated with Chemotherapy

“…(44) Chemotherapy can also cause loss of bone, which increases fracture risk, especially in older populations. (45,46) Bisphosphonate drugs such as ZA and denosumab prevent bone loss and fractures in patients with bone-wasting disorders. (47,48) Patients with bone metastases or treated with certain chemotherapies are also treated with denosumab or a bisphosphonate to prevent bone loss.…”

“…Chemotherapy treatment is effective at combating tumor cell growth and proliferation, but an array of chemotherapy drugs cause loss of muscle mass and muscle weakness, which reduces a patient's quality of life . Chemotherapy can also cause loss of bone, which increases fracture risk, especially in older populations . Bisphosphonate drugs such as ZA and denosumab prevent bone loss and fractures in patients with bone‐wasting disorders .…”