High prevalence of vertebral fractures in women with breast cancer starting aromatase inhibitor therapy

Bouvard, Béatrice; Hoppé, Emmanuel; Soulié, P; Georgin-Mège, M.; Jadaud, É.; Abadie‐Lacourtoisie, Sophie; Manac’h, Audrey Petit Le; Laffitte, A.; Levasseur, Régis; Audran, Maurice; Chappard, Daniel; Legrand, Érick

doi:10.1093/annonc/mdr356

Cited by 44 publications

(27 citation statements)

References 34 publications

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“…Patient categories at the highest risk of osteoporosis are (in descending order): premenopausal women with chemotherapy-induced menopause treated with GnRH agonists, men on androgen deprivation, women switched from tamoxifen to aromatase inhibitors, women on aromatase inhibitors, especially if aged <70 years (52,54,55). Given the high prevalence of risk factors for fractures, irrespective of hormone therapy, and the high prevalence of vertebral fracture at cancer diagnosis, all subjects with breast or prostate cancer should be assessed for fragility fractures (including morphometric vertebral fractures) (56,57). Aminobisphosphonates and denosumab are the first line drugs for the management of bone health in breast and prostate cancer, being able to prevent BMD loss during adjuvant hormonal therapy.…”

Section: Adjuvant Hormonal Therapymentioning

confidence: 99%

Guidelines for the diagnosis, prevention and management of osteoporosis

et al. 2016

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Osteoporosis poses a significant public health issue. National Societies have developed Guidelines for the diagnosis and treatment of this disorder with an effort of adapting specific tools for risk assessment on the peculiar characteristics of a given population. The Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS) has recently revised the previously published Guidelines on the diagnosis, riskassessment, prevention and management of primary and secondary osteoporosis. The guidelines were first drafted by a working group and then approved by the board of SIOMMMS. Subsequently they received also the endorsement of other major Scientific Societies that deal with bone metabolic disease. These recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on leading experts' experience and opinion, and on good clinical practice. The osteoporosis prevention should be based on the elimination of specific risk factors. The use of drugs registered for the treatment of osteoporosis are recommended when the benefits overcome the risk, and this is the case only when the risk of fracture is rather high as measured with variables susceptible to pharmacological effect. DeFRA (FRAX® derived fracture risk assessment) is recognized as a useful tool for easily estimate the long-term fracture risk. Several secondary forms of osteoporosis require a specific diagnostic and therapeutic management

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Section: Adjuvant Hormonal Therapymentioning

confidence: 99%

Guidelines for the diagnosis, prevention and management of osteoporosis

et al. 2016

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“…Third generation non-steroidal (anastrozole and letrozole) and steroidal (exemestane which is similar to androstenedione) AI drugs inhibit the aromatase enzyme by 96-99 % [51], with substantial reduction in oestrogen concentrations (Table 2). AI-induced bone loss is generally more rapid and severe than bone loss in normal postmenopausal women [15], and should be taken into account especially when treated women with low BMD and/or fracture [59]. The skeletal effects observed are inversely correlated with baseline BMD and serum estradiol concentrations.…”

Section: Aromatase Inhibitorsmentioning

confidence: 99%

Cancer-associated bone disease

Rizzoli

Body²,

Brandi³

et al. 2013

Osteoporos Int

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125

103

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Bone is commonly affected in cancer. Cancer-induced bone disease results from the primary disease, or from therapies against the primary condition, causing bone fragility. Bone-modifying agents, such as bisphosphonates and denosumab, are efficacious in preventing and delaying cancer-related bone disease. With evidence-based care pathways, guidelines assist physicians in clinical decision-making. Of the 57 million deaths in 2008 worldwide, almost two thirds were due to non-communicable diseases, led by cardiovascular diseases and cancers. Bone is a commonly affected organ in cancer, and although the incidence of metastatic bone disease is not well defined, it is estimated that around half of patients who die from cancer in the USA each year have bone involvement. Furthermore, cancer-induced bone disease can result from the primary disease itself, either due to circulating bone resorbing substances or metastatic bone disease, such as commonly occurs with breast, lung and prostate cancer, or from therapies administered to treat the primary condition thus causing bone loss and fractures. Treatment-induced osteoporosis may occur in the setting of glucocorticoid therapy or oestrogen deprivation therapy, chemotherapy-induced ovarian failure and androgen deprivation therapy. Tumour skeletal-related events include pathologic fractures, spinal cord compression, surgery and radiotherapy to bone and may or may not include hypercalcaemia of malignancy while skeletal complication refers to pain and other symptoms. Some evidence demonstrates the efficacy of various interventions including bone-modifying agents, such as bisphosphonates and denosumab, in preventing or delaying cancer-related bone disease. The latter includes treatment of patients with metastatic skeletal lesions in general, adjuvant treatment of breast and prostate cancer in particular, and the prevention of cancerassociated bone disease. This has led to the development of guidelines by several societies and working groups to assist physicians in clinical decision making, providing them with evidencebased care pathways to prevent skeletal-related events and bone loss. The goal of this paper is to put forth an IOF position paper addressing bone diseases and cancer and summarizing the position papers of other organizations. Epidemiology of cancer-associated bone disease Bone metastasisCancer affects nearly 12.7 million people and is associated with over 7 million deaths in 2008 [1]. Cancer is a rising global health burden and it is estimated that in 2030, cancer deaths will be tallied at over 13 million (World Health Organization (WHO) 2010 Global Status Report [2]). Addressing the morbidity and mortality of cancer is an important public health concern. On purpose, we are limiting our analysis to cancer bone involvement in adults and do not discuss cancer in children.Metastases from cancer are associated with 90 % of cancer deaths [3]. It was estimated that one half of people who die from cancer in the USA have bone involvement [4][5][6]. Different tumou...

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“…With the use of aromatase inhibitors, there is a time and dose dependent increase risk of fractures (14). This effect is more pronounced in patients with low baseline BMD and serum estrogen concentrations (15). Androgen deprivation therapy with GnRH agonists and antagonists used in the management of breast and prostate malignancies also lead to bone loss by decreasing the estrogen levels.…”

Section: 0 Pathophysiology Of Bone Disease In Cancer Patientsmentioning

confidence: 99%

Evaluation and management of skeletal disease in cancer care

Kommalapati

Tella

Esquivel

et al. 2017

Critical Reviews in Oncology/Hematology

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Recently, there have been considerable advancements in cancer therapies thereby prolonging the life of cancer survivors. However, these recent advancements present new challenges in the management of bone disease in cancer survivors. Bone acts as a fertile soil for cancer seeding and bone health is often compromised because of increased inflammatory cytokines in cancer, direct cancer metastasis and toxic effects of anti-cancer therapies. This effect is more pronounced in elderly population who already have compromised bone mineral density leading to increased skeletal related events and bone pain. Timely diagnosis and effective interventions are essential for reducing bone-related morbidity in cancer survivors. Also, a complex interdependence exists between cancer related bone disease and tumor growth, creating a vicious circle of extensive bone destruction and cancer progression. Hence, maintenance of bone health and integrity plays a pivotal role in comprehensive cancer care. The bone-targeted treatments have been shown to preserve bone health, and modify the course of the underlying cancer. Management of long-term bone health requires a broad knowledge base that both endocrinologists, oncologists and other care team members should be aware of. The manuscript highlights the skeletal effects of cancer, adjuvant therapies used for hormone-responsive cancers, chemotherapy induced bone loss and steps for accurate diagnosis and management of bone disease in cancer survivors by bridging the gaps in the comprehensive cancer care.

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High prevalence of vertebral fractures in women with breast cancer starting aromatase inhibitor therapy

Abstract: Before starting aromatase inhibitor therapy for breast cancer, a large proportion of women had a vitamin D insufficiency and vertebral fractures.

Cited by 44 publications

References 34 publications

Guidelines for the diagnosis, prevention and management of osteoporosis

Guidelines for the diagnosis, prevention and management of osteoporosis

Cancer-associated bone disease

Evaluation and management of skeletal disease in cancer care

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