Practical guidance for the management of aromatase inhibitor-associated bone loss

Abstract

The authors recommend the following for preventing and treating AIBL in women with breast cancer. All patients initiating AI therapy should receive calcium and vitamin D supplements. Any patient initiating or receiving AI therapy with a T-score >/=-2.0 and no additional risk factors should be monitored every 1-2 years for change in risk status and bone mineral density (BMD). Any patient initiating or receiving AI therapy with a T-score <-2.0 should receive bisphosphonate therapy. Any patient initiating or receiving AI therapy with any two of the following risk factors-T-score <-1.5, age >65 years, low BMI (<20 kg/m(2)), family history of hip fracture, personal history of fragility fracture after age 50, oral corticosteroid use >6 months, and smoking-should receive bisphosphonate therapy. BMD should be monitored every 2 years, and treatment should continue for at least 2 years and possibly for as long as AI therapy is continued. To date, the overwhelming majority of clinical evidence supports zoledronic acid 4 mg every 6 months to prevent bone loss in women at high risk. Although there is a trend towards fewer fractures with zoledronic acid, studies completed to date have not been designed to capture significant differences in fracture rate, and longer follow-up is needed.

Incidence of bisphosphonate‐associated osteonecrosis of the jaws in breast cancer patients

“…Both chemotherapy and aromatase inhibitors have a negative impact on the bone mineral density. 23,24 Therefore, an additional impact on the risk for BP-ONJ cannot be ruled out. Unfortunately, anticancer medication accompanying bisphosphonate therapy had not been fully reported in most other series.…”

A study of the effects of the aromatase inhibitors anastrozole and letrozole on bone metabolism in postmenopausal women with estrogen receptor-positive breast cancer

“…Randomized clinical trials such as the Zometa-Femara Adjuvant Synergy Trial (Z-FAST in the United States and ZO-FAST in Europe) support the use of zoledronic acid (4 mg), a bisphosphonate, every 6 months to prevent AI-associated bone loss [17,18]. In addition to calcium and vitamin D supplementation, any patient who is starting AI therapy and has a T-score \ -2.0 should receive zoledronic acid (4 mg) twice yearly [19]. Zoledronic acid is also being recommended for any patient who is receiving AI therapy and has any two of the following risk factors: T-score \ -1.5, age [ 65 years, family history of hip fracture, personal history of fragility fracture after age 50, or oral corticosteroid use [6 months [19].…”

“…In addition to calcium and vitamin D supplementation, any patient who is starting AI therapy and has a T-score \ -2.0 should receive zoledronic acid (4 mg) twice yearly [19]. Zoledronic acid is also being recommended for any patient who is receiving AI therapy and has any two of the following risk factors: T-score \ -1.5, age [ 65 years, family history of hip fracture, personal history of fragility fracture after age 50, or oral corticosteroid use [6 months [19]. It is evident that both anastrozole and letrozole cause a significant increase in the bone turnover markers studied here, and that these effects increase over time.…”

Letrozole in ovulation induction (a review)

“…Пер-вичные негативные эффекты включают признаки менопаузы (сухость влагалища, сексуальная дис-функция), желудочно-кишечные расстройства и воздействие на скелетно-мышечную систему, вклю-чая деминерализацию костей с высоким риском раз-вития остеопороза и переломов, артралгий и миал-гий [51]. Использование ИА является фактором ри-ска развития остеопороза [52]. Все пациенты, полу-чающие ИА, должны дополнительно принимать ви-тамин D и источники кальция.…”