The causes and treatment of bone loss associated with carcinoma of the breast

Lester, J.; McCloskey, Eugène; Coleman, Robert E.

doi:10.1016/j.ctrv.2005.01.008

Cited by 59 publications

(34 citation statements)

References 117 publications

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“…In premenopausal women, chemotherapy-induced ovarian failure and surgical or medical ovarian ablation can cause premature menopause and bone loss [35,37]. Premenopausal women with hormone-responsive breast cancer may also undergo adjuvant estrogen deprivation, which also increases bone loss [35,36].…”

Section: Bone Diseasementioning

confidence: 99%

“…In selecting endocrine therapy, physicians and patients must weigh the higher risk for fractures associated with AIs against the higher risk for endometrial and cerebrovascular/thromboembolic morbidity associated with TAM [54]. Patients at increased risk for fracture can be readily identified, monitored, and managed proactively according to current American Society for Clinical Oncology (ASCO) treatment guidelines [37,43,54]. Indeed, monitoring of bone health and interventions to reduce fracture risk can be recommended for the general population, and the results from the Z-FAST study suggest that routine BMD monitoring and, if necessary, interventions with bisphosphonates are good defenses for breast cancer patients.…”

Section: Ais and Bone Diseasementioning

confidence: 99%

“…While TAM has a beneficial effect on bone health [37], all three AIs appear to increase bone loss and, therefore, may increase the risk for fractures in the long term [43].…”

Section: Ais and Bone Diseasementioning

confidence: 99%

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Appraising Adjuvant Aromatase Inhibitor Therapy

Perez

2006

The Oncologist

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Tamoxifen, once the gold standard adjuvant endocrine therapy for early breast cancer, is being challenged by third-generation aromatase inhibitors (AIs) that have demonstrated improved disease-free survival in a variety of adjuvant settings for early breast cancer. Tamoxifen and AIs have different safety profiles, which should allow physicians to begin to individualize treatment based on a patient's comorbidities and risk factors. Because of its properties as a partial estrogen agonist, tamoxifen has a positive effect on serum lipids and may confer a cardioprotective benefit, as well as a beneficial effect on bone health. However, tamoxifen increases the risk for endometrial cancer and cerebrovascular/thromboembolic events. In comparison, the major side effect of AIs is increased bone loss, which may heighten the risk for osteoporotic fractures and bone pain. Because of their superior efficacy and manageable side effects, AIs are a cost-effective alternative to tamoxifen, and clinical guidelines now embrace AIs as appropriate adjuvant therapy for hormone-sensitive early breast cancer. The anticipated results of ongoing trials will provide further insights into the long-term safety and application of AI therapy in the adjuvant setting.

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Section: Bone Diseasementioning

confidence: 99%

Section: Ais and Bone Diseasementioning

confidence: 99%

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Appraising Adjuvant Aromatase Inhibitor Therapy

Perez

2006

The Oncologist

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“…Chemotherapy may induce ovarian failure in up to 70% of women (Petrek et al, 2006;Stearns et al, 2006), and the resulting oestrogen depletion can lead to bone loss (Saarto et al, 1997). In addition, chemotherapy can have direct detrimental effects on bone density through an inhibition of bone proliferation (Lester et al, 2005). It is well recognised that endocrine therapies for breast cancer can have variable effects on bone mineral density (BMD), depending on the pharmaceutical agent and the patient population (Chien and Goss, 2006;Perez et al, 2006;Coleman et al, 2007;Eastell et al, 2008).…”

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confidence: 99%

Lack of association between oestrogen receptor polymorphisms and change in bone mineral density with tamoxifen therapy

et al. 2009

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BACKGROUND: Tamoxifen, a selective oestrogen receptor (ER) modulator, increases bone mineral density (BMD) in postmenopausal women and decreases BMD in premenopausal women. We hypothesised that inherited variants in candidate genes involved in oestrogen signalling and tamoxifen metabolism might be associated with tamoxifen effects in bone. METHODS: A total of 297 women who were initiating tamoxifen therapy were enrolled in a prospective multicentre clinical trial. Lumbar spine and total hip BMD values were measured using dual-energy X-ray absorptiometry (DXA) at baseline and after 12 months of tamoxifen therapy. Single-nucleotide polymorphisms (SNPs) in ESR1, ESR2, and CYP2D6 were tested for associations in the context of menopausal status and previous chemotherapy, with a mean percentage change in BMD over 12 months. RESULTS: The percentage increase in BMD was greater in postmenopausal women and in those patients who had been treated with chemotherapy. No significant associations between tested SNPs and either baseline BMD or change in BMD with 1 year of tamoxifen therapy were detected. CONCLUSION: The evaluated SNPs in ESR and CYP2D6 do not seem to influence BMD in tamoxifen-treated subjects.

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“…All of the AIs have been associated with an increased risk of fractures and bone loss of approximately 2% per year (Lester et al, 2005). Over a 5-year period of treatment with an AI, an average of 7 -8% loss of bone is estimated, equivalent to an average reduction in T score of À1.0 or a doubling of fracture risk (Marshall et al, 1996).…”

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confidence: 99%

Current management of treatment-induced bone loss in women with breast cancer treated in the United Kingdom

et al. 2005

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New therapeutic options in breast cancer have improved survival but consequently increase the relevance of late complications. Ovarian suppression/ablation and aromatase inhibitors (AI) in the adjuvant setting have improved outcome, but have clinically important adverse effects on bone health. However, investigation and management of cancer treatment-induced bone loss (CTIBL) is poorly defined with no national guidance. In 2004, a questionnaire was sent to over 500 breast surgeons and oncologists who treat breast cancer within the United Kingdom. The questionnaire evaluated access to bone densitometry and specialist expertise as well as attitudes to investigation of CTIBL and anticipated changes in the use of AI for postmenopausal early breast cancer. A total of 354 completed questionnaires were received, 47 from clinicians not currently treating breast cancer. Of the 307 evaluable questionnaires, 164 (53%) were from breast surgeons, 112 (36%) from clinical oncologists and 31 (10%) from medical oncologists. Although most respondents recognised that CTIBL was the responsibility of the treating breast team, investigations for CTIBL are limited even though most had adequate access to bone densitometry; 98 (32%) had not requested a DXA scan in the last 6 months and 224 (73%) had requested fewer than five scans. In all, 235 (76%) were not routinely investigating patients on AI for bone loss. A total of 277 (90%) felt that their practice would benefit from national guidelines to manage these patients, and the majority (59%) had little or no confidence in interpreting DXA results and advising on treatment. This questionnaire has highlighted clear deficiencies in management of CTIBL in early breast cancer. The development of national guidelines for the management of these patients and educational initiatives for breast teams are urgently required.

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The causes and treatment of bone loss associated with carcinoma of the breast

Cited by 59 publications

References 117 publications

Appraising Adjuvant Aromatase Inhibitor Therapy

Appraising Adjuvant Aromatase Inhibitor Therapy

Lack of association between oestrogen receptor polymorphisms and change in bone mineral density with tamoxifen therapy

Current management of treatment-induced bone loss in women with breast cancer treated in the United Kingdom

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