Management of cancer treatment-induced bone loss in early breast and prostate cancer - a consensus paper of the Belgian Bone Club

Abstract

Cancer treatment-induced bone loss (CTIBL) is one of the most important side effects of adjuvant antineoplastic treatment in hormone-dependent neoplasms. Chemotherapy, GnRH analogs and tamoxifen can induce marked bone loss in premenopausal women with early breast cancer. Aromatase inhibitors (AIs) are replacing tamoxifen as the preferred treatment for postmenopausal women. As a class effect, steroidal (exemestane) and non-steroidal (anastrozole and letrozole) AIs increase bone turnover and cause bone loss (4%-5% over 2 years). When compared to tamoxifen, the risk of getting a clinical fracture under AI treatment is increased by 35%-50%. In patients with prostate cancer, androgen deprivation therapy (ADT) increases bone turnover, reduces bone mass (4%-5% per year) and increases the fracture rate depending on the duration of therapy. Zoledronic acid can prevent accelerated bone loss induced by goserelin in premenopausal women, by letrozole in postmenopausal women and by ADT in men. More limited data indicate that weekly alendronate or risedronate could also be effective for preventing CTIBL. Initiation of therapy early, prior to the occurrence of severe osteoporosis, rather than after, may be more effective. Bisphosphonate treatment should be considered in osteoporotic but also in osteopenic patients if other risk factor(s) for fractures are present.

Cancer Treatment-Induced Bone Loss in women with breast cancer

“…35 These guidelines recommend antiresorptive treatment in patients receiving AI with a T-score below À 2.0 or having two or more clinical risk factors for fracture. 36,37 Recently, the European Society for Medical Oncology (ESMO) confirmed the reported risk factors that increase fracture risk in postmenopausal women with BC. Recommendation level A is assigned for the flow for fracture risk assessment, prevention and treatment of AIBL, which is enclosed in (figure 3).…”

Adverse effects of adjuvant endocrine therapy

“…Разработаны международные рекомендации по про-филактике снижения костной плотности у больных, получающих ГТ [53,54]. Пациенткам на протяжении всего периода приема ИА необходимо рекомендовать умеренные физические нагрузки, богатую кальцием диету или кальциевые добавки, а также прием витамина Д в дозах 1000-2000 МЕ в сутки [53,54].…”

“…Пациенткам на протяжении всего периода приема ИА необходимо рекомендовать умеренные физические нагрузки, богатую кальцием диету или кальциевые добавки, а также прием витамина Д в дозах 1000-2000 МЕ в сутки [53,54]. Перед началом адъювантной ГТ необходима оценка состояния костной системы методом двухуровневой рентгеновской денси-тометрии.…”

Effect of calcitonin on anastrozole-induced bone pain during aromatase inhibitor therapy for breast cancer

“…But the benefits of anastrozole in treating breast cancer have been accompanied by additional treatment-related toxicity. Therefore, patients with endocrine cancers have an increased risk of osteoporosis as a complication of cancer treatment (Hoff and Gagel, 2005;Body et al, 2007). Bone loss induced by hormone therapy appears in early breast cancer due to hypoestrogenism, and chemotherapy with resultant ovarian failure may also cause bone loss.…”