Assessing fracture risk in early stage breast cancer patients treated with aromatase-inhibitors: An enhanced screening approach incorporating trabecular bone score

Mariotti, Veronica; Page, David B.; Davydov, Oksana; Hans, Didier; Hudis, Clifford A.; Patil, Sujata; Kunte, Siddharth; Girotra, Monica; Farooki, Azeez; Fornier, Monica

doi:10.1016/j.jbo.2016.10.004

Cited by 27 publications

(17 citation statements)

References 19 publications

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“…Similar results were found in premenopausal breast cancer women treated with zoledronic acid (113). Therefore, TBS could be suitable to improve the fracture risk definition in CTIBL patients and could be usefully combined with FRAX and BMD to maximise the identification of patients with elevated risk (114).…”

Section: Hypogonadismsupporting

confidence: 68%

“…Moreover, since BMD in many conditions is not impaired or it is even higher than expected (4,43,84,85,122,123), the fracture risk prediction by FRAX may be improved by excluding BMD in the algorithm computation (4,124,125,126) or by downward adjusting BMD by 0.5 standard deviation (39). Finally the TBS-adjusted FRAX, being TBS an independent fracture risk capturing 'quality' aspects of bone structure, has suggested to possibly improve the absolute fracture risk definition in secondary osteoporosis (114,127,128).…”

Section: Fracture Risk Assessment In Secondary Osteoporosismentioning

confidence: 99%

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DIAGNOSIS OF ENDOCRINE DISEASE: Evaluation of bone fragility in endocrine disorders

Eller-Vainicher

Falchetti

Gennari

et al. 2019

European Journal of Endocrinology

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An underlying disease affecting bone health is present in up to 40 and 60% of osteoporotic postmenopausal women and men respectively. Among the disorders leading to a secondary form of osteoporosis, the endocrine diseases are highly represented. A frequent finding in patients affected with an endocrine-related forms of bone disease is that the skeletal fragility is partially independent of the bone density, since the fracture risk in these patients is related more to a reduction of bone quality than to a decrease of bone mass. As a consequence, bone mineral density evaluation by dual-X-ray absorptiometry may be inadequate for establishing the risk of fracture in the setting of the endocrine-related forms of osteoporosis. In the recent years, several attempts to non-invasively estimating bone quality have been done. Nowadays, some new tools are available in the clinical practice for optimising the fracture risk estimation in patients with endocrine disorders. The aim of this review is to summarise the evidence regarding the role of the different imaging tools for evaluating bone density and bone quality in the most frequent forms of endocrine-related osteoporosis, such as obesity, diabetes, acromegaly, thyrotoxicosis, primary hyperparathyroidism, hypercortisolism and hypogonadism. For each of these disorders, data regarding both the current available tools and the future possible new techniques for assessing bone fragility in patients with endocrine diseases are reported.

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Section: Hypogonadismsupporting

confidence: 68%

Section: Fracture Risk Assessment In Secondary Osteoporosismentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: Evaluation of bone fragility in endocrine disorders

Eller-Vainicher

Falchetti

Gennari

et al. 2019

European Journal of Endocrinology

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“…Therefore, TBS seems to be a better measure of bone fragility in individuals who are obese/overweight, and useful in assessing the osteoporotic fracture risk, with lower TBS values associated to a higher risk. Also, it could be suitable to improve the fracture risk definition in patients with CTIBL and could be usefully combined with FRAX and BMD to optimise the identification of patients with breast cancer and elevated risk 93. However, it has not been validated in PCa, and, therefore, no recommendation for its routine use can be made.…”

Section: Optimising Bone Health Management: An Expert Opinionmentioning

confidence: 99%

Bone health management in the continuum of prostate cancer disease: a review of the evidence with an expert panel opinion

et al. 2020

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Bone health impairment is a frequent detrimental consequence of the high bone tropism of prostate cancer (PCa) cells. It is further worsened by administration of androgen-deprivation therapy (ADT), the current standard of care in the management of advanced PCa, through a rapid and dramatic increase in bone turnover and body mass changes. As a result, patients may experience substantial pain and poor quality of life (QoL) and have an increased risk of death. Notwithstanding the importance of this issue, however, bone health preservation is not yet a widespread clinical goal in daily practice. To address this urgent unmet need, following a thorough discussion of available data and sharing of their clinical practice experience, a panel of Italian experts in the field of bone health and metabolism formulated a number of practical advices for optimising the monitoring and treatment of bone health in men undergoing ADT during all phases of the disease. The rationale behind the venture was to raise awareness on the importance of bone preservation in this complex setting, while providing an instrument to support physicians and facilitate the management of bone health. Current evidence regarding the effects on bone health of ADT, of novel hormone therapies (which improve progression delay, pain control and QoL while consistently carrying the risk of non-pathological fractures in both non-metastatic and metastatic PCa) and of bone turnover inhibitors (whose use is frequently suboptimal) is reviewed. Finally, the expert opinion to optimise bone health preservation is given.

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“…The aim of this study was to compare baseline BMD, TBS, and fracture risk in women under the age of 60 with BC to a control group. Additionally to the common BMD measurements of the spine, proximal femur, and total hip we used the TBS, the FRAX and the TBS adjusted FRAX score to optimize fracture risk prediction as recently shown in a population of women with breast cancer receiving AI therapy [15]. According to WHO criteria, 57.1% of women in our BC group had osteopenia (42.3% of the control group), whereas 16.3% had osteoporosis (18.6% control group).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of baseline fracture risk in younger postmenopausal women with breast cancer using different risk assessment methods

et al. 2020

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Objective Controversy exists about the impact of bone mineral density (BMD) and fracture risk in newly diagnosed patients with breast cancer (BC). It is presumed that there are differences in BMD between women with BC and healthy controls. BMD is therefore considered as a potential marker to predict BC risk. This study was conducted to investigate the association of BMD, trabecular bone score (TBS) and fracture risk in younger postmenopausal women with hormone responsive BC. Methods Overall, 343 women were examined. Women with BC were matched to a control group of the general population. Forty-nine women and fifty-nine controls were included in the final analysis. All subjects underwent dual energy x-ray absorptiometry (DXA) of the lumbar spine, femoral neck, and the total hip to evaluate bone mineral density. The 10-year fracture risk for a major osteoporotic fracture was assessed using the FRAX-score and the TBS-adjusted FRAX-Score, respectively. Results Lumbar and femoral neck BMD were similar in BC patients and controls. No difference was found for TBS of the spine (1.38 ± 0.1 vs.1.36 ± 0.09) in the BC and the control group, respectively (p = 0.19). The 10-year probability for a major osteoporotic fracture (MoF) or femoral neck (FN) fracture was 6.1 (± 2.6%) and 0.9 (± 1.2%) in the BC group vs. 6.7 (± 3.5%) (p = 0.33) and 0.9 (± 1.1%) (p = 0.73) in the control group. Conclusion Postmenopausal women younger than 60 years with breast cancer do not show any differences in baseline BMD, TBS, or TBS adjusted FRAX in comparison to controls.

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Assessing fracture risk in early stage breast cancer patients treated with aromatase-inhibitors: An enhanced screening approach incorporating trabecular bone score

Cited by 27 publications

References 19 publications

DIAGNOSIS OF ENDOCRINE DISEASE: Evaluation of bone fragility in endocrine disorders

DIAGNOSIS OF ENDOCRINE DISEASE: Evaluation of bone fragility in endocrine disorders

Bone health management in the continuum of prostate cancer disease: a review of the evidence with an expert panel opinion

Evaluation of baseline fracture risk in younger postmenopausal women with breast cancer using different risk assessment methods

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