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Zoledronic acid for treatment of osteopenia and osteoporosis in women with primary breast cancer undergoing adjuvant aromatase inhibitor therapy: a 5-year follow-up

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Abstract

Purpose

This study was designed to explore whether zoledronic acid could prevent expected loss of bone mineral density (BMD) in postmenopausal women with pre-existing osteopenia or osteoporosis who were initiating adjuvant letrozole therapy for primary breast cancer.

Methods

Between June 2006 and July 2007, 60 postmenopausal women with estrogen and/or progesterone receptor-positive breast cancer and a BMD T-score ≤−2.0 were enrolled. Participants received letrozole 2.5 mg and vitamin D 400 IU daily, calcium 500 mg twice daily, and zoledronic acid 4 mg every 6 months for a maximum of 5 years or until disease progression. BMD at the lumbar spine and femoral neck was recorded at the start of the study and annually for 5 years. Patients were evaluated for fractures every 6 months for the duration of the trial.

Results

After 5 years, mean BMD increased significantly by 11.6 % (p = 0.01) at the lumbar spine and by 8.8 % (p = 0.01) at combined sites. Femoral neck BMD increased by 4.2 %, although this was not significant (p = 0.23). At the end of the trial, BMDs were consistent with osteoporosis in 7 % and osteopenia in 36 % of the patients. A total of six fractures were reported after 417 individual assessments.

Conclusions

Zoledronic acid appears to prevent further bone loss in postmenopausal breast cancer patients with osteopenia and osteoporosis starting treatment with letrozole. These findings were maintained at 5 years and support concurrent initiation of bisphosphonate and aromatase inhibitor therapy in this high-risk population.

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Conflict of interest

The authors declare that they have no competing interests. All primary data is under the control of the investigators and is available for review by the journal if requested.

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Authors and Affiliations

  1. Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Neil Majithia

  2. Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Pamela J. Atherton & Janet Olson

  3. Department of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Jacqueline M. Lafky & Charles L. Loprinzi

  4. Department of Medical Oncology, Washington University School of Medicine, 660 S. Euclid Ave, Box 8056, St Louis, MO, 63110, USA

    Nina Wagner-Johnston

  5. Cancer Center of Kansas, 818 N. Emporia #403, Wichita, KS, 67214, USA

    Shaker R. Dakhil

  6. Department of Hematology and Oncology, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA

    Edith A. Perez

  7. Department of General Internal Medicine, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA

    Stephanie L. Hines

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  1. Neil Majithia
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Majithia, N., Atherton, P.J., Lafky, J.M. et al. Zoledronic acid for treatment of osteopenia and osteoporosis in women with primary breast cancer undergoing adjuvant aromatase inhibitor therapy: a 5-year follow-up. Support Care Cancer 24, 1219–1226 (2016). https://doi.org/10.1007/s00520-015-2915-2

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  • DOI: https://doi.org/10.1007/s00520-015-2915-2

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