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Denosumab effect on bone mineral density and urinary-NTX in breast cancer patients receiving aromatase inhibitors

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Abstract

Introduction

Aromatase inhibitors are used post-surgical intervention in postmenopausal patients with breast cancer. However, these drugs accelerate decline in bone mineral density (BMD), which is countered by use of denosumab, and the efficacy of the drug can be assessed by bone turnover markers. We investigated the effects of denosumab administration for 2 years on BMD and urinary N-telopeptide of type I collagen (u-NTX) levels in breast cancer patients treated with aromatase inhibitors.

Materials and methods

This was a single-center retrospective study. Postoperative hormone receptor-positive breast cancer patients with low T-scores biannually received denosumab from the time of initiation of aromatase inhibitor therapy for 2 years. BMD was measured every 6 months, and u-NTX levels were assessed after 1 month and thereby every 3 months.

Results

The median patient age of the 55 patients included in this study was 69 (range: 51–90) years. BMD gradually increased in the lumbar spine and femoral neck and u-NTX levels were lowest at 3 months post-initiation of therapy. Patients were divided into two groups based on the change ratio of u-NTX 3 months post-denosumab administration. Of these, the group with higher change ratio showed a higher degree of BMD restoration in the lumbar spine and femoral neck 6 months post-denosumab treatment.

Conclusion

Denosumab increased BMD in patients treated with aromatase inhibitors. The u-NTX level decreased soon after start of denosumab treatment, and its change ratio is predictive of improvement in BMD.

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Acknowledgements

We thank the patients and their families for their participation in this study.

Funding

The authors declare that they did not receive any funding for this study.

Author information

Authors and Affiliations

  1. Department of Breast Surgery, Yokkaichi Municipal Hospital, 2-2-37 Shibata, Yokkaichi-City, Mie, 510-8567, Japan

    Masahiro Shibata, Mai Okumura, Shin Kawano, Hirotoshi Noda, Chihiro Toyota & Yutaka Mizuno

  2. Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan

    Masahiro Shibata

Authors
  1. Masahiro Shibata
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  2. Mai Okumura
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  3. Shin Kawano
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  4. Hirotoshi Noda
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  5. Chihiro Toyota
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  6. Yutaka Mizuno
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Contributions

Conceptualization: YM; data curation: MO, SK, HN, CT, YM; methodology: MS, MO, YM; formal analysis and investigation: MS, MO, YM; writing—original draft preparation: MS; writing—review and editing: MO, SK, HN, CT, YM; supervision: YM.

Corresponding author

Correspondence to Masahiro Shibata.

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Conflict of interest

The authors have stated that they have no conflicts of interest to declare.

Ethical approval

This study was approved by the Institutional Review Board Committee of the Yokkaichi Municipal Hospital (No. 2017-18). All procedures involving human participants were performed in accordance with the ethical standards of the institutional committee and the Declaration of Helsinki. As this was a retrospective study, formal consent was not required.

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Supplementary Information

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774_2023_1429_MOESM1_ESM.pptx

Supplementary Fig. 1 Correlation between clinical factors and bone mineral density (BMD) change ratios after six months. There was no significant correlation between BMD change ratios and age (a), years since menopause (b), or body mass index (c) (Spearman's rank correlation test.). (PPTX 94 KB)

774_2023_1429_MOESM2_ESM.pptx

Supplementary Fig. 2 Association between clinical factors and bone mineral density (BMD) change ratios after six months. There was no significant association between BMD change ratios and history of fracture (a) or type of aromatase inhibitors (b) (N.S., not significant, Mann–Whitney U test.). (PPTX 80 KB)

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Shibata, M., Okumura, M., Kawano, S. et al. Denosumab effect on bone mineral density and urinary-NTX in breast cancer patients receiving aromatase inhibitors. J Bone Miner Metab 41, 567–574 (2023). https://doi.org/10.1007/s00774-023-01429-8

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  • DOI: https://doi.org/10.1007/s00774-023-01429-8

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