Bone health and quality of life in breast cancer patients treated by aromatase inhibitors

Abstract

Breast cancer (BC) is the most frequent malignant tumor in women in Europe and in North America. The use of the aromatase inhibitors (AIs) is recommended in women affected by (BC) with estrogen receptor-positive (ER + ) tumors. The AIs, blocking the enzyme converting androgens into estrogens, induce a reduction in bone mineral density (BMD), with a resulting increased risk of fragility fractures in the women. Therefore, BC patients treated by AIs require an adequate anti-osteoporotic treatment (bisphosphonates or denosumab) and a supplementation of calcium and vitamin D. Aim of this observational study was to evaluate the bone health and the quality of life (QoL) in a cohort of BC patients treated by AIs. We included ER+ BC adult women (aged > 18 years), undergone surgical treatment, in treatment with AIs. For all patients we recorded comorbidities and anti-osteoporotic treatment. We assessed: BMD, using dual X-ray absorptiometry (DXA), fragility fracture rate, and QoL, using the 12-Item Short-Form Health Survey (SF-12) and its components: Physical Composite Scale (PCS) and Mental Health (MCS). We assessed 118 patients, mean aged 68.80 ± 10.18 years with a mean BMI of 29.0 ± 2.8 kg/m 2 . We prescribed bisphosphonates in 80 patients (67.8%), risedronate in 68 and alendronate in 12, denosumab in 38 (32.2%), and a supplementation with calcium and vitamin D in the entire cohort. Fragility fracture rate occurred in 17.79% of women included. Mean values of SF12 scores were: SF12 PCS = 43.6 ± 2.33 and MCS = 50.0 ± 2.12. In our cohort of BC patients treated by AIs, there was a fragility fracture rate of 17.8%, testifying the importance of an adequate anti-osteoporotic treatment in these patients.