Use of aromatase inhibitors in patients with breast cancer is associated with deterioration of bone microarchitecture and density

Abstract

Objective: To evaluate changes in bone density and architecture in postmenopausal women with breast cancer (BC) and use of aromatase inhibitor (AI). Subjects and methods: Thirty-four postmenopausal women with BC, without bone metastasis, renal function impairment and who were not receiving bone-active drugs were selected from a population of 523 outpatients treated for BC. According to the presence of hormonal receptors, HER2 and Ki67, seventeen had positive hormonal receptors and received anastrozole (AI group), and seventeen were triple-negative receptors (non-AI group), previously treated with chemotherapy. Areal bone mineral density (aBMD) and vertebral fracture assessment (VFA) analyses were performed by DXA; vBMD and bone microarchitecture were evaluated by HR-pQCT. Fracture risk was estimated using the FRAX tool. Results: No patient referred previous low-impact fracture, and VFA detected one moderate vertebral fracture in a non-AI patient. AI patients showed lower aBMD and BMD T-scores at the hip and 33% radius and a higher proportion of osteoporosis diagnosis on DXA (47%) vs non-AI (17.6%). AI group had significantly lower values for vBMD at the entire, cortical and trabecular bone compartments, cortical and trabecular thickness and BV/TV. They also had a higher risk for major fractures and for hip fractures estimated by FRAX. Several HR-pQCT parameters evaluated at distal radius and distal tibia were significantly associated with fracture risk. Conclusion: AI is associated with alterations in bone density and microarchitecture of both the cortical and trabecular compartments. These findings explain the overall increase in fracture risk in this specific population.

Muscle strength is associated with fracture risk obtained by fracture risk assessment tool (FRAX) in women with breast cancer

“…In this context, the Fracture Risk Assessment Tool (FRAX) represents an important advance in the assessment of this risk [6]. The few studies discussing the use of FRAX in women with breast cancer have concluded that FRAX scores stratify fracture risk equally well between women undergoing endocrine therapy with AI and non-users, and that all patients who start treatment with AI should have their fracture risk assessed [9,10].…”

Letrozole administration effects on the P450aromatase expression and the reproductive parameters in male sheep (Ovis aries)

“…Several studies have reported Aromatase inhibitor administration in recent years (Akça et al, 2022). Letrozole, in a specific manner, has been used in cancer treatment, sex reversal studies, and treatment of male infertility (Nunes et al, 2021;Shen et al, 2015;Yang et al, 2021). In this study, we aimed to address the effects of letrozole administration in male ovine models for the first time.…”

Combinatorial Therapy of Letrozole- and Quercetin-Loaded Spanlastics for Enhanced Cytotoxicity against MCF-7 Breast Cancer Cells

“…Therefore, the specific inhibition of estrogen levels in the breast tissue could be more beneficial for disease management. Additionally, local estrogen inhibition could overcome the side effects reported from patients under hormonal therapy, resulting from depletion of the circulating estrogen as hot flashes [8] and bone deterioration [9]. Therefore, beyond the more patient compliance achieved with the drug transdermal delivery, it provides high drug concentration at the site of application and low plasma drug concentration with reduced systemic side effects.…”