Guidance for the prevention of bone loss and fractures in postmenopausal women treated with aromatase inhibitors for breast cancer: an ESCEO position paper

Abstract

Summary Aromatase inhibitors (AIs) are widely used in women with breast cancer, but they are known to increase bone loss and risk of fractures. Based on available evidence and recommendations, an ESCEO working group proposes specific guidance for the prevention of AIs-induced bone loss and fragility fractures. Introduction Aromatase inhibitors (AIs) are now the standard treatment for hormone receptor-positive breast cancer. However, deleterious effects of AIs on bone health have beenreported. An ESCEO working group proposes guidance for the prevention of bone loss and fragility fractures in postmenopausal women with breast cancer receiving AIs. Methods A panel of experts addressed the issue of skeletal effects of AIs and effectiveness of antifracture therapies for the prevention of AI-induced bone loss and fractures. Recommendations by national and international organizations, and experts' opinions on this topic were evaluated. Results All aromatase inhibitors are associated with negative effects on the skeleton, resulting in bone loss and increased risk of fragility fractures. Current guidelines suggest approaches that differ both in terms of drugs proposed for fracture prevention and duration of treatment. Conclusion The ESCEO working group recommends that all AI-treated women should be evaluated for fracture risk. Besides general recommendations, zoledronic acid 4 mg i.v. every 6 months, denosumab s.c., or possibly oral bisphosphonates should be administered for the entire period of AI treatment to all osteoporotic women (T-score hip/spine <−2.5 or ≥1 prevalent fragility fracture), to women aged ≥75 irrespective of BMD, and to patients with T-score <−1.5+≥1 clinical risk factor or T-score <−1.0+≥2 clinical risk factors. Alternatively, therapy could be considered in patients with a FRAX-determined 10-year hip fracture probability ≥3%.

Mind the (treatment) gap: a global perspective on current and future strategies for prevention of fragility fractures

“…Accordingly, key observations on the impact of each class on BMD and fracture risk are indicated in table 6, primarily in accordance with the findings of Panday et al in their 2014 review on medication-induced osteoporosis [81]. Recent literature reviews specific to each drug class are also cited to provide the reader with a source of more detailed current information [82][83][84][85][86][87][88][89][90][91]. A focus on three commonly used classes -glucocorticoids, androgen deprivation therapy and aromatase inhibitors -serves to illustrate the potential benefits of strategies to prevent osteoporosis induced by medicines.…”

“…A systematic approach to fragility fracture care and prevention for New Zealand [66,67] Reproduced with kind permission of Osteoporosis New Zealand Fracture Liaison Service models of care of varying intensity and outcomes [33] van der Kruijs et al [84] Aromatase inhibitors The annual rate of bone loss in women taking AIs is approx. 2.5% as compared to 1-2% for healthy postmenopausal women [85].…”

“…In 2012, the European Society for Clinical and Economical Aspects of Osteoporosis (ESCEO) published guidance on prevention of bone loss and fractures in postmenopausal women treated with AIs [85]. Key recommendations included:…”

“…Rizzoli et al [85] Calcineurin inhibitors The direct effect of CIs on BMD is not clear due to post-transplant GC use and compromised bone health before transplants.…”

The analysis of comorbidities in geriatric patients with proximal femur fracture

“…У 95 % випадків переломи ПВСК є травмами «низької енер-гії», спричиненої, у більшості випадків падінням з висоти власного тіла [6,7]. Відомо, що низькоенерге-тичні переломи нерідко пов'язані з супутніми захво-рюваннями, порушенням ходи, дефіцитом статевих гормонів, недоїданням [8].…”