Risk of Cancer Treatment—Associated Bone Loss and Fractures Among Women with Breast Cancer Receiving Aromatase Inhibitors

Mincey, Betty A.; Duh, Mei Sheng; Thomas, Simu K.; Moyneur, Érick; Marynchencko, M.; Boyce, Simone Peart; Mallett, David; Perez, Edith A.

doi:10.3816/cbc.2006.n.021

Cited by 86 publications

(65 citation statements)

References 25 publications

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“…tamoxifen) were excluded. Those receiving AIs had a 27% increased risk of bone loss (p = 0.02) and a 21% increased risk of fracture (p = 0.02) [15]. Earlier findings with the steroidal AI exemestane had suggested some androgenic action (and potentially more bone-sparing effects) for this AI [16].…”

Section: Adjuvant Endocrine Therapy and Bone Healthmentioning

confidence: 99%

Women and Bone Health: Maximizing the Benefits of Aromatase Inhibitor Therapy

Tang¹

2010

Oncology

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Postmenopausal women with early breast cancer (EBC) are already at risk for bone loss, osteoporosis and fracture as they age because of declining estrogen levels. Adjuvant hormonal therapy with aromatase inhibitors (AIs; e.g. letrozole, anastrozole, exemestane) can exacerbate this risk. All three AIs appear to have similar effects on bone, increasing bone turnover and fracture risk in postmenopausal women with EBC. Risk factors for bone loss can be used to assess fracture risk and the need for ongoing assessment and/or treatment in postmenopausal women receiving AIs for EBC. The concomitant, up-front use of intravenous bisphosphonate therapy, such as zoledronic acid, in combination with AIs can inhibit bone loss. In addition, a strong body of evidence suggests an anticancer activity of bisphosphonate therapy with zoledronic acid in EBC in both the pre- and postmenopausal adjuvant setting. Zoledronic acid thus provides a therapeutic option for postmenopausal women with EBC who may be at higher risk for bone loss while on AIs, allowing more patients to receive treatment with effective adjuvant hormonal therapy to prevent recurrence.

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Section: Adjuvant Endocrine Therapy and Bone Healthmentioning

confidence: 99%

Women and Bone Health: Maximizing the Benefits of Aromatase Inhibitor Therapy

Tang¹

2010

Oncology

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“…Another study in healthy postmenopausal volunteers (NZ77) showed that all three AIs increased levels of bone resorption markers (Goss et al 2003). Likewise, in a retrospective longitudinal analysis of 1354 women with breast cancer, the prevalence of osteoporosis/osteopenia (8.7 vs 7.1%; PZ0.01) and bone fracture (13.5 vs 10.3%; PZ0.001) was significantly higher in the AI than non-AI group on univariate analysis; similarly, on multivariate analysis, the increase in risk of osteoporosis and fracture was 27 and 21% respectively (Mincey et al 2006).…”

Section: Aromatase Inhibitorsmentioning

confidence: 99%

Menopausal symptoms and adjuvant therapy-associated adverse events

Hadji¹

2008

Endocrine Related Cancer

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Third-generation aromatase inhibitors (AIs) are replacing tamoxifen as adjuvant therapy in postmenopausal women with hormone-sensitive breast cancer due to their superiority shown in several recent head-to-head trials. Healthy postmenopausal women normally experience age-related side effects, and in postmenopausal women with breast cancer, these symptoms may be exacerbated by adjuvant endocrine therapy. This review evaluates the current literature regarding bone health, lipid metabolism, cardiovascular disease, gynecologic health, and cognition in postmenopausal women receiving adjuvant AI therapy. The AIs -anastrozole, exemestane, and letrozole -are generally well tolerated: most adverse events are mild to moderate and common to menopause. Common short-term AI-associated toxicities are hot flushes, musculoskeletal complaints/arthralgia, and bone loss, all of which can be effectively managed. AIs may lack the cardioprotective and lipid-lowering effects of tamoxifen but, in contrast to tamoxifen, do not increase the risk of serious life-threatening thromboembolic or cerebrovascular events or endometrial cancer. Every patient should be individually assessed with respect to therapy risks and benefits. Lifestyle, comorbidities, and concomitant medications must be considered, and the importance of compliance to adjuvant therapy should be discussed before selecting a treatment regimen. The superior efficacy of adjuvant AI therapy will in most cases outweigh the risk of bothersome side effects that can be prevented or easily managed.

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“…Female patients receiving adjuvant treatment for early breast cancer are at significant risk of cancer treatmentinduced bone loss (CTIBL) due to cytotoxic chemotherapy-induced menopause, and hormonal therapies with aromatase inhibitors [1][2][3][4]. Patients with CTIBL, are at high risk for bone fractures and may complain for chronic pain, loss of mobility, and even shorter survival [5,6].…”

Section: Introductionmentioning

confidence: 99%

Osteonecrosis of the jaw and use of bisphosphonates in adjuvant breast cancer treatment: a metanalysis

Mauri

Valachis

Polyzos³

et al. 2009

Breast Cancer Res Treat

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To estimate the cumulative randomized evidence for the overall incidence of bisphosphonates induced jaw osteonecrosis in adjuvant treatment of breast cancer. Systematic review and meta-analysis of randomized clinical trials. Trials were located through PubMed, ISI, Cochrane Library, and major cancer scientific meetings searches. We identified 15 studies reporting data on osteonecrosis of the jaw. A total of 10,694 randomized women were included, of whom 5,312 received bisphosphonates and 5,382 received either placebo or no treatment.

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Risk of Cancer Treatment—Associated Bone Loss and Fractures Among Women with Breast Cancer Receiving Aromatase Inhibitors

Cited by 86 publications

References 25 publications

Women and Bone Health: Maximizing the Benefits of Aromatase Inhibitor Therapy

Women and Bone Health: Maximizing the Benefits of Aromatase Inhibitor Therapy

Menopausal symptoms and adjuvant therapy-associated adverse events

Osteonecrosis of the jaw and use of bisphosphonates in adjuvant breast cancer treatment: a metanalysis

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