AB1006 Bone status of patients treated with anti-aromatase: results at one year

Abstract

BackgroundFirst cancer in Algeria, first cause of cancer mortality in women. One in 10 women will develop breast cancer in her lifetime. Its incidence is increasing with 55.8/100000 inhabitants. The majority of these cancers are hormone-dependent. The bone loss induced by anti-aromatase (AA) leads to an increase in bone resorption with bone loss 2 to 4 times greater than the physiological loss.Randomised controlled trials (RCTs) including women under AA for 5 years have suggested an increased risk of fracture of 18% to 20% ie 1 in 5 women will experience this risk.ObjectivesThe aim of our work is to describe the initial bone status and after one year of follow-up in patients starting an anti-aromatase.MethodsThree hundred and twenty seven (327) patients were recruited from the oncology department of Tizi Ouzou University Hospital, 292 patients were analysed in the initial phase of the study and only 250 patients were evaluated at one year. Of these patients, 157 non-osteoporosis patients received calcium and vitamin d-related health care and 93 patients were osteoporotic and treated with calcium and vitamin D bisphosphonates.- Inclusion criteria:Women with oestrogen receptor breast cancer Treatment with anti-aromatase indicated: a- Immediately after conventional breast treatment b- Tamoxifen relay- Criteria for non-inclusion: Bone metastasesMethodsClinical evaluation: screener risk factors for osteoporosis and fractures. Biological Evaluation: Calcium, Phosphoremia, 25 Hydroxy Vitamin D. Radiological assessment: chest radiograph (profile) or IVA (vertebral fracture assessment) looking for vertebral fracturesLumbar and femoral bone densitometry (HOLOGIC QDR)ResultsThe mean age of the patients is 56.8±7.3 years, mean body mass index is 27.4±2.8 kg/m2. 48% of patients received chemotherapy. The anti-aromatases were given as follows: Anastrozole in 64%, Letrozole in 14% and Exemestane in 11%. At baseline assessment n=292, 31.6% of patients had densitometric osteoporosis (T score <-2) in the lumbar spine and 9.5% in the femoral neck. 37 patients have a history of peripheral fracture. Six patients have at least one vertebral fracture. The average level of vitamin D is 15.2±3.5 ng/L.6 – 29 283 patients or 97% have a deficiency in vit D (<30 ng/L). After one year of follow-up, patients without osteoporosis (n=157), annual bone loss is 1.5% at the lumbar spine and 1.24% at the hip. 16 patients became osteoporotic. Four patients developed a new vertebral fracture. The one-year follow-up result in osteoporotic patients treated with bisphosphonates with calcium and vitamin D (n=93) had stable bone mineral density (0.3% non-significant bone loss). 57% of patients still have vitamin D insufficiency and two patients had a new vertebral fracture.ConclusionsAntiaromatases lead to an increased risk of osteoporosis. It is important to evaluate the fracture risk of breast cancer patients through a rheumatology consultation to find all the risk factors, to detect frequent calcium and vitamin D deficiencies and to treat osteoporosis.Di...