Abstract
PurposeThe administration of aromatase inhibitors is associated with bone loss in postmenopausal women. We assessed changes in bone mineral density (BMD) from baseline to 60 months of treatment in patients receiving anastrozole as initial adjuvant therapy.MethodsPostmenopausal women with hormone receptor-positive breast cancer receiving anastrozole as adjuvant therapy at our center since 2004 were enrolled in this study. BMD was assessed by dual-energy X-ray absorptiometry at baseline and after 6, 12, 24, 36, 48 and 60 months. Oral bisphosphonate (Bis) treatment was initiated when patients were diagnosed with osteoporosis having a T-score of −2.5 or lower.ResultsFifty-five patients were enrolled in the study between 2004 and 2011, and the mean follow-up period was 53.6 months. Thirty-five patients were administered Bis (risedronate in 27 patients, alendronate in 8 patients). After 6 months of hormone therapy, BMD decreased by 0.5% from baseline at the lumbar spine (LS) and BMD decreased by 1.5% at the femoral neck (FN). However, BMD increased by 1.9% at the LS and BMD decreased by 1.5% at the FN for 60 months of treatment. In patients treated with upfront Bis (n = 19), 5.4% BMD increase from baseline was noted at the LS whereas in those without Bis (n = 21) BMD decreased by 4.3% from baseline within 24 months (P < 0.0001). Fractures were observed in 4 patients (7.3%), and 1 patient (1.8%) had a fragility fracture.ConclusionsUpfront treatment of Bis with anastrozole significantly increased BMD at the LS and an optimal use of Bis would not increase bone fractures.Trial registrationUMIN0000017571
Highlights
Aromatase inhibitors (AIs) such as anastrozole, exemestane, or letrozole are currently part of the standard endocrine therapy in postmenopausal women with hormone-receptor positive early breast cancer (Goldhirsh et al 2013; Dowsett et al 2009)
Inoue et al SpringerPlus (2015) 4:303 and study of anastrozole with the bisphosphonate risedronate (SABRE) trial (Van Poznak et al 2010) show that AIs have been associated with bone mineral loss and an increase of bone fracture
We assessed changes in bone mineral density (BMD) from baseline to 60 months of treatment in patients receiving anastrozole as initial adjuvant therapy adding Bis according to the status of bone loss
Summary
Aromatase inhibitors (AIs) such as anastrozole, exemestane, or letrozole are currently part of the standard endocrine therapy in postmenopausal women with hormone-receptor positive early breast cancer (Goldhirsh et al 2013; Dowsett et al 2009). Bisphosphonate (Bis) therapy improves bone mineral loss in patients with osteoporosis (Van Poznak et al 2010; Black et al 1996; Harris et al 1999). One substudy of the ATAC trial indicated the changes of bone mineral density (BMD) for 7 years (Eastell et al 2008). We assessed changes in BMD from baseline to 60 months of treatment in patients receiving anastrozole as initial adjuvant therapy adding Bis according to the status of bone loss. This is the first report of the changes of BMD due to 5 years’ treatment of anastrozole for patients including osteoporosis
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