Abstract
The purpose of this study was to compare the changes in DXA values including trabecular bone score (TBS) and bone mineral density (BMD) of lumbar spine (LS) and femur according to the hormone therapies including tamoxifen (TMXF) treatment with or without gonadotropin releasing hormone analog (GnRH analog) in women with breast cancer. We enrolled 119 women with breast cancer who had undergone breast-conserving surgery or mastectomy followed by TMXF treatment for postmenopausal women (TMXF group, n = 63, 52.9%) or by combination therapy of TMXF combined with GnRH analog for premenopausal women (TMXF + GnRH group, n = 56, 47.1%) from December 2013 to December 2017. The median follow-up period was 13 months (interquartile range [IQR], 12.0–14.75) for TMXF group and 13.5 months (IQR, 12.00–16.00) for TMXF + GnRH group, respectively. Patients did not receive bone-modifying therapy. The baseline dual-energy X-ray absorptiometry (DXA) scan before breast cancer surgery and follow-up DXA during hormone therapy. Comparing the first and follow-up DXA results, BMD in LS were significantly decreased in both TMXF (P < 0.001, mean difference: − 0.06) and TMXF + GnRH (P < 0.001, mean difference: − 0.09) groups. BMD values of femoral neck (P = 0.0011, mean difference: − 0.01) and total femur (P < 0.001, mean difference: − 0.03) was significantly changed between the baseline and follow-up DXA in TMXF + RnRH group. In the TMX group, a significant changed occurred in the BMD in total femur (P < 0.001, mean difference: − 0.030) but not the BMD of femoral neck (P = 0.095, mean difference: − 0.007). Regarding TBS, no significant change was found in the TMXF (P = 0.574, mean difference: − 0.004) group, whereas there was a significant decrease in TBS in the TMXF + GnRH (P < 0.001, mean difference: − 0.02) group during follow-up. TBS is more sensitive in reflecting the bone microarchitecture changes by TMXF or GnRH agonist in breast cancer patients than BMD. This finding demonstrates that TBS can be a useful parameter to detect bone microarchitectural changes in clinical applications.
Highlights
Hormone-receptor positive cancers are the most common type of breast cancer, accounting for 75% of all breast cancers[1,2,3]
Patients were eligible for the study if they met the following criteria: patients being treated with TMXF only for postmenopausal women (TMXF group), or with TMXF combined with GnRH for premenopausal women (TMXF + GnRH group), for more than 6 months, and who had no bone modifying therapy at any time
Zoladex was added as a GnRH therapy for all patients in TMXF + GnRH group
Summary
Hormone-receptor positive cancers are the most common type of breast cancer, accounting for 75% of all breast cancers[1,2,3]. From the perspective of bone health, ovarian function suppression using gonadotropin-releasing hormone analog (GnRH analog) has the potential to increase the osteoporotic fracture risk of patients because of its estrogen-depriving effect[9,10,11]. In a breast cancer prevention study, aromatase inhibitor therapy for 2 years compared to placebo was associated with loss of volumetric BMD and cortical thickness at a radius of − 4.3% and − 6.8%, respectively, whereas bone loss by DXA was < 2% at all s ites[15]. In a study about the effect of endocrine treatment on densitometric results, results were discordant between the change in BMD and TBS in a TMXF group and an aromatase inhibitor group of postmenopausal women with breast cancer[16]. We used BMD and TBS to investigate how these endocrine treatments affect bone microarchitecture in breast cancer patients
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