Assessment of fracture risk in women with breast cancer using current vs emerging guidelines

Abstract

BACKGROUND: Breast cancer (BC) therapies can have negative effects on bone. Current guidelines recommend antiresorptive therapy based on bone mineral density (BMD), and emerging guidelines include both clinical risk factors and BMD to assess the overall fracture risk. A retrospective, case -controlled study based on current and emerging guidelines was conducted in women with newly diagnosed BC to identify those who were at increased fracture risk based on current and emerging guidelines. METHODS: Baseline characteristics, fracture risk factors, and lumbar -spine (LS) and total-hip BMD in women with BC (88 premenopausal and 402 postmenopausal) were assessed to determine who would receive bisphosphonate therapy based on current and emerging guidelines. RESULTS: Among patients with estrogen-receptor-positive (ER þ ) BC, 18.8% of premenopausal and 36.9% of postmenopausal women were osteopenic at LS. In the postmenopausal cohort, osteoporosis was more prevalent in patients with ER þ vs ER -BC. Current guidelines identified 8.9% of patients as eligible for antiresorptive therapy, clinical risk factors alone identified 6.5%, and BMD plus clinical risk factors identified 28.6%. CONCLUSIONS: In addition to fracture risk factors present at BC diagnosis, cancer therapies leading to BMD loss further increase fracture risk. Evaluating both BMD and clinical risk factors may allow more effective identification of BC patients with elevated fracture risk.

Effect of adjuvant chemotherapy on carboxytelopeptide of cross-linked type I collagen of egyptian women with non-metastatic breast cancer

“…Consequently, total T-and Z-Scores after chemotherapy were also significantly (p<0.001) lower than those before chemotherapy, confirming that bone loss was directly related to treatment with adjuvant chemotherapy. In line with this, many studies reported that adjuvant chemotherapy may cause a rapid bone loss, increasing the risk of osteoporosis for pre-and postmenopausal women with BC later in life [1][2][3][4][5][6][7][24][25][26][27]. It has been shown that bone loss with aging occurs because hypogonadism may progress to primary osteoporosis.…”

“…BC accounts for 37.6% of all reported tumors in Egyptian females, with an age-adjusted incidence rate of 49.6 per 100,000 females [2]. BC, prostate cancer, and multiple myeloma have particularly shown strong doi: 10.7243/2057-1631-1-1 association with skeletal metastases and related bone loss, resulting in fracture, hypercalcemia, pain, and declines in mobility and performance status [3,4].…”

“…Thus, women with BC are at increased risk for the development of osteoporosis and skeletal fractures, giving rise to significant morbidity and some mortality [3], as a consequence of aromatase inhibition or chemotherapyinduced ovarian failure [4,5]. Exemestane and anastrozole, two chemotherapeutic aromatase inhibitors, have been shown to directly inhibit osteoclast differentiation and bone resoption markers leading to osteoporosis in postmenopausal women with non-metastatic breast cancer (NMBC) [6].…”

Aromatase inhibitor-associated bone loss and its management with bisphosphonates in patients with breast cancer

“…34,70 The case study discussed herein represents one potential illustrative example. The patient concerned would not have been eligible for zoledronic acid treatment based on her scans at 12 months because the t score was more than −2 and there was an absence of other risk factors, eg, family history.…”

Guidelines for Osteoprotection in Breast Cancer Patients on an Aromatase Inhibitor

“…A significant difference in fracture rate was observed between letrozole (5.7%) and the tamoxifen arm (4.0%; p < 0.001) at 25.8 months of median [46,58]. Evaluating both BMD and clinical risk factors may allow for the most effective identification of breast cancer patients with increased risk of fracture and the appropriate use of preventative therapies [59].…”