Bone Density in Breast Cancer: When to Intervene?

Abstract

The increased fracture risk associated with treatment-related loss of bone mineral density is an increasingly important problem for women diagnosed with breast cancer. In premenopausal patients, chemotherapy-induced ovarian failure and adjuvant ovarian suppression/ablation can lead to rapid and profound loss of bone mineral density. 1 In addition, in contrast to its bone mineral density–preserving effects seen in the postmenopausal setting, tamoxifen is associated with decreases in bone mineral density in premenopausal women. 2,3 In postmenopausal patients, the progressive loss of bone density associated with natural ovarian failure and aging, and the increasingly common use of adjuvant aromatase inhibition, which exacerbates the estrogen deprivation state, contribute to increased osteoporosis and fracture rates. In recognition of the increasing impact of cancer treatment on our patients’ bone health, the 2003 American Society of Clinical Oncology (ASCO) clinical practice guideline panel on bisphosphonates and bone health in women with breast cancer stated strongly that “oncology professionals, especially medical oncologists, need to take an expanded role in the routine and regular assessment of osteoporosis risk in women with breast cancer.” 4