Bone mineral density loss during adjuvant chemotherapy in pre-menopausal women with early breast cancer: is it dependent on oestrogen deficiency?

Abstract

mineral density loss during adjuvant chemotherapy in pre-menopausal women with early breast cancer: is it dependent on oestrogen deficiency?. Breast Cancer Research and Treatment, Springer Verlag, 2010, 123 (3) Pre-menopausal women given adjuvant chemotherapy for breast cancer experience both premature ovarian failure and loss of bone mineral density (BMD), and this study was designed to see if these observations are causally linked. MethodsChemotherapy was administered to 41 pre-menopausal women with early breast cancer enrolled prospectively in a study of ovarian function and BMD in such women given systemic therapy. After giving written informed consent, all patients underwent baseline and regular on-treatment measurements of BMD by dual-energy x-ray absorptiometry (DXA) scan, bone turnover and ovarian function by analysis of serum hormone levels and self-reported menstrual diaries. ResultsBaseline lumbar spine BMD in the 41 women given chemotherapy was higher than the normal population (Z score 0.28±0.14 (mean±sem), p=0.047), and fell significantly over the first six months from a mean of 1.05 to 1.01 g/m 2 , p <0.0001, and similar but smaller changes were demonstrated in hip BMD. This fall was independent of age at diagnosis, type of chemotherapy, development of amenorrhoea or either baseline or on-treatment estradiol concentration. During the six months after completion of adjuvant chemotherapy, BMD fell further only in those women with low estradiol or experiencing amenorrhoea during the first six months, although all groups showed evidence of increased bone turnover. ConclusionsThis study demonstrates loss of both spine and hip BMD in pre-menopausal women during six months' adjuvant systemic chemotherapy to be independent of changes in ovarian function. Ovarian function was however related to BMD changes after chemotherapy ceased.3

The Protective Role of Simvastatin on Methotrexate-Induced Bone Injury in Adult Albino Rat

“…This "MTX osteopathy" was characterized by osteoporosis, bone pain, and compression fractures [12] . Also, women given chemotherapy consisting of MTX for breast and ovarian cancers may suffer from bone loss [13] .…”

Low Bone Mineral Density in Middle-Aged Breast Cancer Survivors: Prevalence and Associated Factors

“…In breast cancer survivors (BCS), ovarian failure resulting from chemotherapy or the reproductive aging process [3] is associated with decreased bone density [4]. Breast cancer patients > 40 years of age are more likely to develop amenorrhea after chemotherapy than younger women [4,5], with rapid bone loss [4,6]. Bone loss starts to accelerate 2 years before the last menstruation, with a significant loss in the 2 years after menopause [7].…”

“…Despite its effects on bone, hormone therapy increases the risk of recurrence in BCS [9]. BMD has previously been investigated in BCS [4][5][6][10][11][12][13]. Some authors have reported an association between chemotherapy-induced ovarian failure and bone loss [4,6].…”

“…Some authors have reported an association between chemotherapy-induced ovarian failure and bone loss [4,6]. Others have suggested that a decrease in BMD may occur in BCS undergoing chemotherapy irrespective of the effect of chemotherapy on ovarian function [5]. Osteoclastic activity may increase from the breast cancer itself, enhancing bone resorption [14].…”

“…A combination of factors may contribute to bone loss, leading to a greater fracture risk in BCS [17]. The frequency of abnormal BMD may vary according to the skeletal site [5,10,11,18]. In a follow-up study of postmenopausal women, a greater reduction in BMD was observed at the lumbar spine than at the femoral neck [18].…”