Welcome from Azeez Farooki, MD
Nonmetastatic breast cancer patients may be susceptible to increased risk for bone loss and may be at increased risk for osteoporotic (fragility) fractures as a result of factors, such as surgical or chemotherapy induced (premature) menopause, as well as adjuvant aromatase inhibitor use with or without gonadotropin-releasing hormone agonists (GnRH agonists).
Bone health in breast cancer is an important topic given the large number of breast cancer survivors. Adjuvant aromatase inhibitors (AI) are a standard of care for many breast cancer patients with data pending as to the optimal duration (minimum of 5 years). The duration of aromatase inhibitor therapy is relevant given data suggesting some recovery of bone mineral density (BMD) after stopping AI therapy and, also given rare but serious adverse effects related to "long term" use of potent antiresorptives, such as bisphosphonates and densoumab.
A final consideration to weigh in the equation of whether a given patient should be treated with bone-protective therapy is the recent meta analysis data of randomized bisphosphonate trials showing a decrease in bone recurrence and an improvement in cancer-specific mortality in postmenopausal women with breast cancer.
Here I present and comment on recent informative studies on this topic.
- The study by Tsa, et al investigated the risk of bone fracture in Asian women, for whom the risk of breast cancer peaks much earlier than in Caucasian women.
- Eastell, et al evaluated the effects of 5 years of anastrozole on bone mineral density, as well as the subsequent effects of discontinuing this agent for 2 years.
- Gnant and co-authors studies the effects of the anti-RANK ligand antibody densosmab on fracture risk, bone health, and safety outcomes in postmenopausal women undergoing adjuvant endocrine therapy with aromatase inhibitors for the treatment of breast cancer.