Osteoporosis: A Long-Term and Late-Effect of Breast Cancer Treatments

Abstract

Osteoporosis is both a long-term effect (occurs during treatment and extends after treatment) and a late-effect (occurs after treatment ends) of breast cancer treatments. The worldwide prevalence of osteoporosis is estimated to be some 200 million patients. About one in three postmenopausal women will experience an osteoporotic (or fragility) fracture of the hip, spine, or wrist. breast cancer treatments, including gonadotropin-releasing hormone (GnRH) agonists, chemotherapy-induced ovarian failure (CIOF), and aromatase inhibitors (AIs), cause bone loss and increase the risks of osteoporosis. Also, breast cancer is a disease of aging, and most of the “one in eight” lifetime risks of breast cancer are in women in their sixth, seventh, and eighth decades. The majority of women diagnosed with breast cancers today will be long-term survivors and experience personal cures. It is the coalescence of osteoporosis with breast cancer, two common and age-related conditions that make osteoporosis relevant in women with breast cancer throughout the continuum from diagnosis, treatment, and survivorship. It is critical to remember that women (and men) will lose bone after age thirty years. However, only certain women will lose bone of sufficient magnitude to merit treatment with anti-osteoporosis drugs. The narrative review is intended for medical, surgical, radiation oncologists, and other mid-level providers, and provides an overview of bone loss and the prevention and treatment of osteoporosis.

Reduction of the Vertebral Bone Mineral Density in Patients with Hodgkin Lymphoma Correlates with Their Age and the Treatment Regimen They Received

“…Yet, despite the clear beneficial effects of these agents, there is ample evidence of an association between steroid therapy and osteopenia/osteoporosis [16,38] in patients with various types of cancer [21,22,[39][40][41]. The NCCN Task Force Reports emphasize the crucial need for the assessment and treatment of cancer therapy-related BMD loss, as an integral part of comprehensive cancer management [42,43].…”

Breast cancer, aromatase inhibitors, and bone health

“…Lifestyle changes that promote bone health include cessation of cigarette smoking and reduction or cessation of alcohol consumption, increasing physical activity including weight-bearing activities, and minimizing the risk of falling. 30 Women should participate in at least 150 minutes of exercise weekly and in strength training at least twice weekly. Education to reduce fall risks is considered vital.…”

Aromatase Inhibitor-Associated Musculoskeletal Syndrome: Understanding Mechanisms and Management

“…The significance of AIMSS is highlighted by the fact that arthralgias and bone health are among the most common reasons women switch from an AI to tamoxifen (40). Gonadotropin-releasing hormone (GnRH) agonists, most commonly used for ovarian function suppression in premenopausal women, are known to cause bone mineral loss predisposing to osteoporosis but uncommonly provoke musculoskeletal pain (41,42). Moreover, fulvestrant, a selective estrogen receptor down-regulator (SERD) approved for use in advanced and metastatic hormone receptor positive breast cancer (43,44), has an incidence of joint disorders comparable to or less than AIs (45)(46)(47) and its effects on bone density are not well defined (48).…”