The efficacy of bisphosphonates in preventing aromatase inhibitor induced bone loss for postmenopausal women with early breast cancer: a systematic review and meta-analysis.

Pooleriveetil Padikkal Anagha,Suchandra Sen

doi:10.1155/2014/625060

Pooleriveetil Padikkal Anagha, Suchandra Sen

Open Access

https://doi.org/10.1155/2014/625060

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Journal: Journal of oncology	Publication Date: Jan 1, 2014
Citations: 28	License type: CC BY 3.0

Affiliation: Kovai Medical Center and Hospital

Abstract

Objectives. We aim to determine the efficacy of bisphosphonates in preventing aromatase inhibitor induced bone loss (AIBL) in postmenopausal women with early breast cancer. The secondary objective was to determine the safety of bisphosphonates. Materials and Methods. We searched electronic databases in a time period of 1995 January to 2013 June. Random effects meta-analytical models were used; between study heterogeneity and publication bias was assessed. Results. A total of six eligible studies reported the BMD T score of LS at 12 months and from that 3 trials of Zoledronic acid compared the change in BMD in immediate ZOL versus delayed ZOL done with subgroups like patients with normal BMD at baseline (OR = 5.402, 95% CI = 1.329–21.959, P value = 0.018) and osteopenic BMD at baseline (OR = 4.008, 95% CI = 2.249–7.143, P value = 0.0002). Both had a significant decrease in BMD that favoured the delayed ZOL; 3 trials of risedronate and ibandronate also had a significant decrease in BMD in AIs alone group. Immediate ZOL versus delayed ZOL also showed increased risk of getting an ADR in immediate group. Conclusion. Third generation bisphosphonates has an effect on BMD of patients who are on treatment of AIs in breast cancer. Furthermore, the patients treated with immediate ZOL had a significantly high risk of musculoskeletal ADR's than patients with delayed ZOL.

Highlights

Breast cancer is the leading cause of premature morbidity and mortality worldwide for women
Inclusion Criteria (i) Randomised control trials published in English language, (ii) Studies that addressed the association between the third-generation bisphosphonates with aromatase inhibitor in breast cancer treatment, (iii) Studies that reported bone mineral density (BMD) T score after the treatment with bisphosphonate and aromatase inhibitor, (iv) Studies that addressed third-generation bisphosphonates, (v) Postmenopausal women with early breast cancer
SABRE trial included in this study investigated the effects of adjuvant anastrazole with or without risedronate on BMD in postmenopausal women with hormone responsive early breast cancer and preexisting lower, moderate, and higher risk of fragility fracture

Summary

Introduction

Breast cancer is the leading cause of premature morbidity and mortality worldwide for women. More than 800,000 women are diagnosed with breast cancer approximately, and an estimated 65% to 75% of the patients with advanced metastases will develop bone metastases during the course of their disease. Over the past few years, many studies had shown that bone metastases are common in patients with breast cancer, which resulted in significant skeletal morbidity [1]. Hormonereceptor-positive breast cancer can be treated by either blocking the ER with agents such as the selective ER modulator tamoxifen, or by reducing the production of oestrogens with aromatase inhibitors (AIs) [2]. In postmenopausal women with breast cancer, AI causes complete suppression of aromatase activity and Journal of Oncology

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