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Abstract
Bone loss and its associated risk of fracture is a serious long-term health issue for breast cancer and prostate cancer survivors. Hormone ablation therapy, in particular aromatase inhibitors (AIs) for breast cancer and androgen deprivation therapy (ADT) for prostate cancer, causes marked reduction in circulating estrogen or testosterone levels, resulting in increased bone resorption, decreased bone mineral density (BMD), and an increased risk of fragility fracture. In several clinical trials with small sample sizes and short follow-up periods, oral and intravenous bisphosphonates have been shown to improve BMD, but not actual fracture rates, in cancer patients on hormone ablation therapy. A number of professional organizations and expert panels recommend the use of bisphosphonates for selected patients at risk. Although bisphosphonates are generally well tolerated, physicians should be aware of safety concerns, including the risk of osteonecrosis of the jaw. With the growing number of older breast and prostate cancer survivors, additional research is needed to characterize patients who would benefit from pharmacotherapy and optimize strategies to prevent cancer treatment-induced bone loss.
Highlights
The most commonly diagnosed non-skin cancers among U.S women and men are breast and prostate, respectively.[1]. Many patients of both cancers are over the age of 65 and may have low bone mineral density (BMD), the risk of falls, or any of a multitude of medical problems that increase the risk of fracture
The objective of this narrative review is to outline the problem of CTIBL in women and men receiving hormone ablation therapy for breast and prostate cancer and to describe recent findings from clinical trials of the pharmacotherapy, mainly bisphosphonates, for CTIBL
A one-year analysis of the ARIBON study found that oral 150 mg ibandronate once monthly prevented bone loss in patients with the baseline T-score -1.0 who are receiving adjuvant anastrozole. These two randomized, double-blinded, placebo-controlled trials suggest that bisphosphonates at the dose and schedule used in postmenopausal osteoporosis are effective in the setting of aromatase inhibitor (AI)-induced bone loss
Summary
The most commonly diagnosed non-skin cancers among U.S women and men are breast and prostate, respectively.[1]. Since most patients are likely to be long-term survivors after breast and prostate cancer diagnosis, it is of vital importance to manage accelerated bone loss from CTIBL and reduce the fracture risk in their remaining lifetime. The objective of this narrative review is to outline the problem of CTIBL in women and men receiving hormone ablation therapy for breast and prostate cancer and to describe recent findings from clinical trials of the pharmacotherapy, mainly bisphosphonates, for CTIBL
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