Bone safety of aromatase inhibitors versus tamoxifen

Lønning, Per Eystein

doi:10.1111/j.1525-1438.2006.00685.x

Cited by 20 publications

(12 citation statements)

References 21 publications

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“…Aromatase inhibitors decrease bone mass and density, and increase fragility fractures incidence compared to tamoxifen [16,17]. In healthy postmenopausal women, the rate of bone loss is about 1-2% per year [18].…”

Section: Assessment Of Skeletal Effects Of Aromatase Inhibitorsmentioning

confidence: 99%

Guidance for the prevention of bone loss and fractures in postmenopausal women treated with aromatase inhibitors for breast cancer: an ESCEO position paper

et al. 2012

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Summary Aromatase inhibitors (AIs) are widely used in women with breast cancer, but they are known to increase bone loss and risk of fractures. Based on available evidence and recommendations, an ESCEO working group proposes specific guidance for the prevention of AIs-induced bone loss and fragility fractures. Introduction Aromatase inhibitors (AIs) are now the standard treatment for hormone receptor-positive breast cancer. However, deleterious effects of AIs on bone health have beenreported. An ESCEO working group proposes guidance for the prevention of bone loss and fragility fractures in postmenopausal women with breast cancer receiving AIs. Methods A panel of experts addressed the issue of skeletal effects of AIs and effectiveness of antifracture therapies for the prevention of AI-induced bone loss and fractures. Recommendations by national and international organizations, and experts' opinions on this topic were evaluated. Results All aromatase inhibitors are associated with negative effects on the skeleton, resulting in bone loss and increased risk of fragility fractures. Current guidelines suggest approaches that differ both in terms of drugs proposed for fracture prevention and duration of treatment. Conclusion The ESCEO working group recommends that all AI-treated women should be evaluated for fracture risk. Besides general recommendations, zoledronic acid 4 mg i.v. every 6 months, denosumab s.c., or possibly oral bisphosphonates should be administered for the entire period of AI treatment to all osteoporotic women (T-score hip/spine <−2.5 or ≥1 prevalent fragility fracture), to women aged ≥75 irrespective of BMD, and to patients with T-score <−1.5+≥1 clinical risk factor or T-score <−1.0+≥2 clinical risk factors. Alternatively, therapy could be considered in patients with a FRAX-determined 10-year hip fracture probability ≥3%.

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Section: Assessment Of Skeletal Effects Of Aromatase Inhibitorsmentioning

confidence: 99%

Guidance for the prevention of bone loss and fractures in postmenopausal women treated with aromatase inhibitors for breast cancer: an ESCEO position paper

et al. 2012

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“…Hypovitaminosis D has been suggested as an underlying etiology in individuals with persistent, nonspecific musculoskeletal pain [43]. In addition to musculoskeletal symptoms, vitamin D deficiency has been implicated in accelerated bone loss in women with breast cancer receiving AI therapy [44]. A possible biologic explanation of AI-induced musculoskeletal symptoms and their improvement with vitamin D supplementation is that reduction in joint estrogen levels may unmask subclinical Vitamin D deficiency.…”

Section: Managing Ai-induced Arthralgiamentioning

confidence: 99%

Musculoskeletal Adverse Events Associated with Adjuvant Aromatase Inhibitors

Khan

O’Dea

Sharma

2010

Journal of Oncology

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Musculoskeletal symptoms including arthralgia and myalgia occur frequently in aging women, particularly during the transition to menopause, when plasma estrogens precipitously decline. In postmenopausal women (PMW) with breast cancer, third-generation aromatase inhibitors (AIs) as adjuvant hormonal therapy have proven to be more effective, and to have a more predictable side effect profile, than tamoxifen. However, AIs further reduce plasma estrogens in PMW, exacerbating musculoskeletal symptoms. Clinical trial data have shown significantly higher incidences of arthralgia and myalgia with AIs compared with women on tamoxifen or placebo. Symptoms may be severe enough to significantly affect quality of life; musculoskeletal symptoms are a frequent reason for discontinuing therapy. In many cases, symptoms can be effectively managed with oral analgesics or other strategies. Early recognition and effective management of musculoskeletal symptoms can help maximize treatment compliance, enabling patients to derive optimal benefit from therapy in terms of preventing recurrence.

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“…7,8 Rates of BMD loss for postmenopausal breast cancer patients receiving AI therapy are significantly greater than for postmenopausal breast cancer patients receiving tamoxifen or a placebo treatment. 7–11 On average, postmenopausal breast cancer patients receiving AI therapy tend to lose about 2.6% of their BMD annually, which is more than double the rate of healthy postmenopausal women. 12 Research clearly demonstrates that as a result of these life-saving treatments, the bone density of women diagnosed with breast cancer is poorer than the bone density among women of the same age without cancer.…”

Section: Introductionmentioning

confidence: 99%

Effects of a Structured Weight-Bearing Exercise Program on Bone Metabolism Among Breast Cancer Survivors: A Feasibility Trial

Peppone

Mustian

Janelsins

et al. 2010

Clinical Breast Cancer

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Purpose Treatments for breast cancer, specifically hormonal therapy, accelerate bone loss (BL) among breast cancer survivors, leading to osteoporosis and an increase in fracture risk. Tai Chi Chuan (TCC) is a moderate form of weight-bearing exercise, equivalent to walking, and it has been shown to improve aerobic capacity and strength among breast cancer survivors and might also be effective in slowing bone loss in breast cancer survivors. This pilot study compared the influence of TCC with that of standard support therapy (ST; exercise control) on BL biomarkers among breast cancer survivors. Patients and Methods Randomly assigned breast cancer survivors (N = 16; median age, 53 years; < 30 months after treatment) completed 12 weeks (3 times per week, 60 minutes per session) of TCC or ST. Serum levels of N-telopeptides of type I collagen (NTx), a marker of bone resorption, and bone-specific alkaline phosphatase (BSAP), a marker of bone formation, were determined according to enzyme-linked immunosorbent assay at baseline and after the intervention. Results Using analysis of covariance, survivors in the TCC group experienced a greater increase in levels of bone formation (BSAP [µg/L]: before, 8.3; after, 10.2; change, 1.9 µg/L and 22.4%), compared with survivors in ST (BSAP [µg/L]: before, 7.6; after, 8.1; change, 0.5 µg/L [6.3%]). Survivors in the TCC group also experienced a significant decrease in bone resorption (NTx [nanomoles bone collagen equivalent; nmBCE]: before, 17.6; after, 11.1; change, −6.5 nmBCE; −36.9%), whereas women in the ST group did not (NTx [nmBCE]: before, 20.8; after, 18.8; change, −2.0 nmBCE; −9.6%). Conclusion This pilot study suggests that weight-bearing exercise exerts positive effects on BL, through increased bone formation and decreased bone resorption. Further examinations of the influence of TCC on bone health are warranted.

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Bone safety of aromatase inhibitors versus tamoxifen

Cited by 20 publications

References 21 publications

Guidance for the prevention of bone loss and fractures in postmenopausal women treated with aromatase inhibitors for breast cancer: an ESCEO position paper

Guidance for the prevention of bone loss and fractures in postmenopausal women treated with aromatase inhibitors for breast cancer: an ESCEO position paper

Musculoskeletal Adverse Events Associated with Adjuvant Aromatase Inhibitors

Effects of a Structured Weight-Bearing Exercise Program on Bone Metabolism Among Breast Cancer Survivors: A Feasibility Trial

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