Women and Bone Health: Maximizing the Benefits of Aromatase Inhibitor Therapy

Tang, Shou Ching

doi:10.1159/000314997

Cited by 7 publications

(8 citation statements)

References 141 publications

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“…Also, treatment with letrozole resulted in significant bone loss: −3.3% and −5.3% (lumbar spine), and −1.4% and −3.6% (total hip) after the 1st and the 2nd year [26]. Decrease in BMD was apparently lower in patients treated with exemestane, possibly related to its steroidal structure: −1.7% and −1.0% (lumbar spine), and −1.4% and −0.8% (total hip) at 6 and 24 months, respectively [26]. These data were confirmed in a recent meta-analysis showing significant BMD reductions both at lumbar spine and total hip: −6.1% and −7.2% for anastrozole at 5 years, −5.3% and −3.6% for letrozole after 2 years, and −4.0% and −2.0% for exemestane at 2 years [27].…”

Section: Assessment Of Skeletal Effects Of Aromatase Inhibitorsmentioning

confidence: 98%

“…A comparative study analyzing data from the same pivotal trials found significant BMD reductions in patients under anastrozole: −2.3%, −4.0%, 6.08% (at lumbar spine) and −1.5%, −3.9%, −7.2% (total hip) after 1, 2, and 5 years, respectively [26]. Also, treatment with letrozole resulted in significant bone loss: −3.3% and −5.3% (lumbar spine), and −1.4% and −3.6% (total hip) after the 1st and the 2nd year [26]. Decrease in BMD was apparently lower in patients treated with exemestane, possibly related to its steroidal structure: −1.7% and −1.0% (lumbar spine), and −1.4% and −0.8% (total hip) at 6 and 24 months, respectively [26].…”

Section: Assessment Of Skeletal Effects Of Aromatase Inhibitorsmentioning

confidence: 99%

“…Cortical and trabecular bone at the radius and tibia in postmenopausal women treated with anastrozole for breast cancer was found to be lower using peripheral quantitative computed tomography [25]. A comparative study analyzing data from the same pivotal trials found significant BMD reductions in patients under anastrozole: −2.3%, −4.0%, 6.08% (at lumbar spine) and −1.5%, −3.9%, −7.2% (total hip) after 1, 2, and 5 years, respectively [26]. Also, treatment with letrozole resulted in significant bone loss: −3.3% and −5.3% (lumbar spine), and −1.4% and −3.6% (total hip) after the 1st and the 2nd year [26].…”

Section: Assessment Of Skeletal Effects Of Aromatase Inhibitorsmentioning

confidence: 99%

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

et al. 2012

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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%.

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Section: Assessment Of Skeletal Effects Of Aromatase Inhibitorsmentioning

confidence: 98%

Section: Assessment Of Skeletal Effects Of Aromatase Inhibitorsmentioning

confidence: 99%

Section: Assessment Of Skeletal Effects Of Aromatase Inhibitorsmentioning

confidence: 99%

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

et al. 2012

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“…33 Some earlier animal research suggested that exemestane may have less effect on bone, 34 but subsequent research did not support this. 35,36 It is possible that exemestane was prescribed more in women who developed metastatic disease. We did not have data on metastatic disease to evaluate this hypothesis, but the time between BC diagnosis and AI initiation provided some evidence that exemestane was not used more frequently in the metastatic setting than letrozole (1080 days vs. 1524 days) but possibly was used more frequently than anastrazole (1080 days vs. 769 days).…”

Section: Discussionmentioning

confidence: 99%

Bone Mineral Density Screening Among Women with a History of Breast Cancer Treated with Aromatase Inhibitors

Spangler

Loggers

et al. 2013

Journal of Women's Health

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Background: Understanding adherence to bone mineral density (BMD) screening after breast cancer (BC) treatment with aromatase inhibitors (AI) is an important first step in preventing or treating BC-related osteoporosis.Methods: This retrospective cohort study assessed receipt and adherence to BMD screening among 342 women diagnosed with BC who were at high risk for osteoporosis after BC treatment with AI between 2004 and 2007. Nonadherence to baseline and annual BMD screening (recommended by 2003 American Society of Clinical Oncology Guidelines) was assessed using descriptive statistics and Poisson regression models accounting for length of AI use and follow-up. Results: In the year before AI initiation, 16% of women received BMD screening. Fifty-six percent had no BMD screening in the14 months after a minimum of 9 months of continuous AI use, and 75% and 66% failed to have BMD screens during the second (14.1-26 month) and third (26.1-38 month) annual time periods after continuous AI use for at least 23 and 35 months, respectively. Overall, 24% had no BMD screening after 35 months of continuous AI use. Statistically significant predictors of nonadherence included predominant exemestane use, BMD screening before AI initiation, and diabetes mellitus history. Postcollege education, geographic region of primary care clinic, and never smoking were associated with a reduced risk of nonadherence. Conclusions: A significant proportion of breast cancer patients treated with AI did not receive guidelinerecommended BMD screening. Findings should raise awareness of the importance of BMD screening and targeting women at increased risk of screening nonadherence.

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“…Because AIs reduce bone density, women who are prescribed an AI are sometimes also prescribed a bisphosphonate,277 a type of medication that decreases bone resorption by disrupting osteoclast function 278. However, bisphosphonates can have serious side effects,279 so they are not prescribed merely as a matter of course 280.…”

Section: Medications Used For Redressing Side Effects Of Bc Treatmentsmentioning

confidence: 99%

Breast Cancer Medications and Vision: Effects of Treatments for Early-stage Disease

Eisner¹,

Luoh²

2011

Current Eye Research

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This review concerns the effects on vision and the eye of medications prescribed at three phases of treatment for women with early-stage breast cancer (BC): (1) adjuvant cytotoxic chemotherapy, (2) adjuvant endocrine therapy, and (3) symptomatic relief. The most common side effects of cytotoxic chemotherapy are epiphora and ocular surface irritation, which can be caused by any of several different regimens. Most notably, the taxane docetaxel can lead to epiphora by inducing canalicular stenosis. The selective-estrogen-receptor-modulator (SERM) tamoxifen, long the gold-standard adjuvant-endocrine-therapy for women with hormone-receptor-positive BC, increases the risk of posterior subcapsular cataract. Tamoxifen also affects the optic nerve head more often than previously thought, apparently by causing subclinical swelling within the first 2 years of use for women older than ∼50 years. Tamoxifen retinopathy is rare, but it can cause foveal cystoid spaces that are revealed with spectral-domain optical coherence tomography (OCT) and that may increase the risk for macular holes. Tamoxifen often alters the perceived color of flashed lights detected via short-wavelength-sensitive (SWS) cone response isolated psychophysically; these altered perceptions may reflect a neural-response sluggishness that becomes evident at ∼2 years of use. The aromatase inhibitor (AI) anastrozole affects perception similarly, but in an age-dependent manner suggesting that the change of estrogen activity towards lower levels is more important than the low estrogen activity itself. Based on analysis of OCT retinal thickness data, it is likely that anastrozole increases the tractional force between the vitreous and retina. Consequently, AI users, myopic AI users particularly, might be at increased risk for traction-related vision loss. Because bisphosphonates are sometimes prescribed to redress AI-induced bone loss, clinicians should be aware of their potential to cause scleritis and uveitis occasionally. We conclude by suggesting some avenues for future research into the visual and ocular effects of AIs, particularly as relates to assessment of cognitive function.

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Women and Bone Health: Maximizing the Benefits of Aromatase Inhibitor Therapy

Cited by 7 publications

References 141 publications

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

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

Bone Mineral Density Screening Among Women with a History of Breast Cancer Treated with Aromatase Inhibitors

Breast Cancer Medications and Vision: Effects of Treatments for Early-stage Disease

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