Aromatase inhibitors (AIs) have become integral to the treatment of women with breast cancer and are the treatment of choice in postmenopausal women who have tumors that are estrogen receptor positive. The depletion of estrogen seen with AI therapy is significant and translates to beneficial tumor effect but has a negative impact on skeletal bone. Bone loss incurred from AI use creates an increased risk for osteoporosis and subsequent bone fractures. Menopausal women have additional bone loss when using AIs. In addition, younger women may develop risk for osteoporosis as a result of premature menopause from other therapies used in the treatment of breast cancer. The process by which a woman treated for breast cancer develops osteoporosis differs from the bone loss that occurs from menopause alone and should be considered as a separate process. The effects of AI therapy on women with breast cancer are profound, and patients may require specialized approaches to therapy. This article will discuss osteoporosis, including assessment and diagnosis, and review the available and experimental treatments, as well as nursing implications in the treatment of women with breast cancer on AI therapy.
Update on Identifying and Managing Osteoporosis in Women With Breast Cancer
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Osteoporosis and Aromatase InhibitorsOsteoporosis is the microarchitectural deterioration of bone leading to bone fragility; it is generally a silent process until a painful fracture occurs (Delaney, 2006). AIs have a profound estrogen depletion effect, reducing estrogen production by more than 95% without the risk of endometrial cancer or thromboembolic events (Altundag & Ibrahim, 2006). Because of their efficacy and risk profile, AIs are the treatment of choice for postmenopausal women with ER+ tumors, and they are approved as first-line therapy for women in this group (Chien & Goss, 2006; Pandya & Morris, 2006). However, one of the most common side effects of AI use is skeletal bone loss leading to thinning of the bone (osteopenia) or risk of bone fractures (osteoporosis).Development of osteoporosis may be a different entity in women with breast cancer, in part because of the use of AIs (Hadji, 2008). Prior to initiating AI therapy, a woman may already be at risk for developing osteoporosis because of her age, comorbidities, dietary and personal habits, and adjuvant treatment for breast cancer. After adjuvant therapies, a woman has a five-fold increased risk for vertebral fracture compared with age-matched controls (Aapro, 2004;Hillner et al., 2003). Thus, the development of osteoporosis in this patient population is multifactorial.Women with breast cancer must be screened and treated for osteoporosis prior to AI therapy. Every oncology nurse should be well prepared to identify patients at risk, ensure screening is performed, and...
