Abstract
9554 Background: AI are increasingly being used as adjuvant endocrine therapy for breast cancer (BC). Patients (pts) receiving AI report a higher incidence of MS and bone fractures; the mechanism and risk factors for this correlation are not well studied. We correlate symptomatology with: bone mineral density (BMD), previous tamoxifen use, and administration of calcium/bisphosphonate (Ca/Bis). Methods: We retrospectively reviewed charts of 856 hormone receptor-positive non-metastatic BC pts between Jan 1999 - Oct 2007. 316 pts met the inclusion criteria of treatment with an AI (anastrozole, letrozole, or exemestane) for at least 3 months and availability of a dual- energy x-ray absorptiometry (DEXA) during this treatment. Arthralgia, generalized bone pain and/or myalgia (GBPM) ≥5/10 points on Visual Analog Pain Scale, bone fracture after beginning AI, any tamoxifen treatment and Ca/Bis therapy were recorded. Results: Table 1 shows a significant association between symptoms and DEXA-BMD results (p<0.001). The more severe the symptoms the greater the likelihood of osteopenia and osteoporosis. Similarly, the group receiving tamoxifen before AI had fewer pts with arthralgia or generalized bone pain/myalgia (GBPM) or bone fracture (p=<0.001) and had more pts with normal BMD (p<0.001). Furthermore, the group receiving AI plus Ca/Bis had more pts without MS symptoms and fewer fractures. Finally, the group receiving steroidal AI compared to non-steroidal AI had more pts with arthralgia or GBPM and bone fractures (p<0.001). Conclusions: Pts on AI who develop osteoporosis are at increased risk of MS symptoms and bone fracture. Co-medication with Ca/Bis reduces the likelihood for osteoporosis and MS symptoms. Pts who received tamoxifen before AI were less likely to develop AI-related MS symptoms. We recommend that pts on AI should be offered Ca/Bis to reduce the incidence of MS symptoms and fracture, especially if pts are receiving steroidal AI and/or did not receive tamoxifen prior to AI. Total Normal BMD Osteopenia (T<-1.5 SD) Osteoporosis (T<-2.5 SD) N N N No MS symptoms 143 92 37 14 Arthralgia + Generalized bone pain/myalgias 138 13 40 85 Clinical bone fracture 35 0 0 35 Mantel-Haenszel correlation test was used No significant financial relationships to disclose.
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