Osteoporosis International

, Volume 23, Issue 11, pp 2567–2576 | Cite as

Guidance for the prevention of bone loss and fractures in postmenopausal women treated with aromatase inhibitors for breast cancer: an ESCEO position paper

  • R. Rizzoli
  • J. J. Body
  • A. De Censi
  • J. Y. Reginster
  • P. Piscitelli
  • M. L. Brandi
  • on behalf of the European Society for Clinical and Economical aspects of Osteoporosis and Osteoarthritis (ESCEO)
Original Article

Abstract

Summary

Aromatase inhibitors (AIs) are widely used in women with breast cancer, but they are known to increase bone loss and risk of fractures. Based on available evidence and recommendations, an ESCEO working group proposes specific guidance for the prevention of AIs-induced bone loss and fragility fractures.

Introduction

Aromatase inhibitors (AIs) are now the standard treatment for hormone receptor-positive breast cancer. However, deleterious effects of AIs on bone health have been reported. An ESCEO working group proposes guidance for the prevention of bone loss and fragility fractures in post-menopausal women with breast cancer receiving AIs.

Methods

A panel of experts addressed the issue of skeletal effects of AIs and effectiveness of antifracture therapies for the prevention of AI-induced bone loss and fractures. Recommendations by national and international organizations, and experts’ opinions on this topic were evaluated.

Results

All aromatase inhibitors are associated with negative effects on the skeleton, resulting in bone loss and increased risk of fragility fractures. Current guidelines suggest approaches that differ both in terms of drugs proposed for fracture prevention and duration of treatment.

Conclusion

The ESCEO working group recommends that all AI-treated women should be evaluated for fracture risk. Besides general recommendations, zoledronic acid 4 mg i.v. every 6 months, denosumab s.c., or possibly oral bisphosphonates should be administered for the entire period of AI treatment to all osteoporotic women (T-score hip/spine <−2.5 or ≥1 prevalent fragility fracture), to women aged ≥75 irrespective of BMD, and to patients with T-score <−1.5 + ≥1 clinical risk factor or T-score <−1.0 + ≥2 clinical risk factors. Alternatively, therapy could be considered in patients with a FRAX-determined 10-year hip fracture probability ≥3%.

Keywords

Aromatase inhibitors Bisphosphonates Bone loss Breast cancer Fracture risk 

References

  1. 1.
    Howlader N, Noone AM, Krapcho M et al (2011) SEER Cancer Statistics Review, 1975-2008, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2008/, based on November 2010 SEER data submission, posted to the SEER web site 2011.
  2. 2.
    Ferlay J, Shin HR, Bray F et al (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917CrossRefPubMedGoogle Scholar
  3. 3.
    Goldhirsch A, Wood WC, Coates AS et al (2011) Strategies for subtypes-dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol 22:1736–1747CrossRefPubMedGoogle Scholar
  4. 4.
    Dowsett M, Cuzick J, Ingle J et al (2010) Meta-analysis of breast cancer outcomes in adjuvant trials of aromatase inhibitors versus tamoxifen. J Clin Oncol 28:509–518CrossRefPubMedGoogle Scholar
  5. 5.
    Mauri D, Pavlidis N, Polyzos NP et al (2006) Survival with aromatase inhibitors and inactivators versus standard hormonal therapy in advanced breast cancer: meta-analysis. JNCI 98:1285–1291CrossRefPubMedGoogle Scholar
  6. 6.
    Cuzick J, Sestak I, Baum M et al (2010) Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 10-year analysis of the ATAC trial. Lancet Oncol 11:1135–1141CrossRefPubMedGoogle Scholar
  7. 7.
    Coombes RC, Kilburn LS, Snowdon CF et al (2007) Survival and safety of exemestane versus tamoxifen after 2-3 years' tamoxifen treatment (Intergroup Exemestane Study): a randomised controlled trial. Lancet 369:559–570CrossRefPubMedGoogle Scholar
  8. 8.
    Thürlimann B, Keshaviah A, Coates AS (2005) A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. Engl J Med 353:2747–2757CrossRefGoogle Scholar
  9. 9.
    Goss PE, Ingle JN, Martino S et al (2005) Randomized trial of letrozole following tamoxifen as extended adjuvant therapy in receptor-positive breast cancer: updated findings from NCIC CTG MA17. J Natl Cancer Inst 97:1262–1271CrossRefPubMedGoogle Scholar
  10. 10.
    Smith IE, Dowsett M (2003) Aromatase inhibitors in breast cancer. N Engl J Med 348:2431–2442CrossRefPubMedGoogle Scholar
  11. 11.
    McCloskey E (2006) Effects of third-generation aromatase inhibitors on bone. Eur J Cancer 42:1044–1051CrossRefPubMedGoogle Scholar
  12. 12.
    Mouridsen HT, Robert NJ (2005) The role of aromatase inhibitors as adjuvant therapy for early breast cancer in postmenopausal women. Eur J Cancer 41:1678–1689CrossRefPubMedGoogle Scholar
  13. 13.
    Perez EA (2007) Safety profiles of tamoxifen and the aromatase inhibitors in adjuvant therapy of hormone-responsive early breast cancer. Ann Oncol 18:26–35CrossRefGoogle Scholar
  14. 14.
    Body JJ, Bergmann P, Boonen S et al (2007) Management of cancer treatment-induced bone loss in early breast and prostate cancer - a consensus paper of the Belgian Bone Club. Osteoporos Int 18:1439–1450CrossRefPubMedGoogle Scholar
  15. 15.
    Burstein HJ, Prestrud AA, Seidenfeld J (2010) American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Clin Oncol 28:3784–3796CrossRefPubMedGoogle Scholar
  16. 16.
    Coates AS, Keshaviah A, Thürlimann B et al (2007) Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine-responsive early breast cancer: update of study BIG 1-98. J Clin Oncol 25:486–492CrossRefPubMedGoogle Scholar
  17. 17.
    Lonning P (2006) Bone safety of aromatase inhibitors versus tamoxifen. Int J Gynecol Cancer 16:518–520CrossRefPubMedGoogle Scholar
  18. 18.
    Kanis JA, Melton LJ, Christiansen C 3rd et al (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141CrossRefPubMedGoogle Scholar
  19. 19.
    Eastell R, Hannon RA, Cuzick J et al (2006) Effect of an aromatase inhibitor on BMD and bone turnover markers: 2-year results of the Anastrozole, Tamoxifen, Alone or in Combination (ATAC) trial (18233230). J Bone Miner Res 21:1215–1223CrossRefPubMedGoogle Scholar
  20. 20.
    Gnant M, Mlineritsch B, Luschin-Ebengreuth G (2008) Adjuvant endocrine therapy plus zoledronic acid in premenopausal women with early-stage breast cancer: 5-year follow-up of the ABCSG-12 bone-mineral density substudy. Lancet Oncol 9:840–849CrossRefPubMedGoogle Scholar
  21. 21.
    Shapiro CL, Manola J, Leboff M (2001) Ovarian failure after adjuvant chemotherapy is associated with rapid bone loss in women with early-stage breast cancer. J Clin Oncol 19:3306–3311PubMedGoogle Scholar
  22. 22.
    Chen Z, Maricic M, Pettinger M et al (2005) Osteoporosis and rate of bone loss among postmenopausal survivors of breast cancer. Cancer 104:1520–1530CrossRefPubMedGoogle Scholar
  23. 23.
    Eastell R, Adams JE, Coleman RE et al (2008) Effect of anastrozole on bone mineral density: 5-year results from the anastrozole, tamoxifen, alone or in combination trial 18233230. J Clin Oncol 26:1051–1057CrossRefPubMedGoogle Scholar
  24. 24.
    Coleman RE, Banks LM, Girgis SI et al (2007) Skeletal effects of exemestane on bone-mineral density, bone biomarkers, and fracture incidence in postmenopausal women with early breast cancer participating in the Intergroup Exemestane Study (IES): a randomised controlled study. Lancet Oncol 8:119–127CrossRefPubMedGoogle Scholar
  25. 25.
    Szabo KA, Webber CE, Adachi JD et al (2011) Cortical and trabecular bone at the radius and tibia in postmenopausal breast cancer patients: a Peripheral Quantitative Computed Tomography (pQCT) study. Bone 48:218–224CrossRefPubMedGoogle Scholar
  26. 26.
    Tang SC (2010) Women and bone health: maximizing the benefits of aromatase inhibitor therapy. Oncology 79:13–26CrossRefPubMedGoogle Scholar
  27. 27.
    Ghazi M, Roux C (2009) Hormonal deprivation therapy-induced osteoporosis in postmenopausal women with breast cancer. Best Pract Res Clin Rheumatol 23:805–811CrossRefPubMedGoogle Scholar
  28. 28.
    Lønning PE, Geisler J, Krag LE (2005) Effects of exemestane administered for 2 years versus placebo on bone mineral density, bone biomarkers, and plasma lipids in patients with surgically resected early breast cancer. J Clin Oncol 23:5126–5137CrossRefPubMedGoogle Scholar
  29. 29.
    Powles TJ, Hickish T, Kanis JA et al (1996) Effect of tamoxifen on bone mineral density measured by dual-energy x-ray absorptiometry in healthy premenopausal and postmenopausal women. J Clin Oncol 14:78–84PubMedGoogle Scholar
  30. 30.
    Ettinger B, Black DM, Mitlak BH et al (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 282:637–645CrossRefPubMedGoogle Scholar
  31. 31.
    Delmas PD, Ensrud KE, Adachi JD et al (2002) Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: four-year results from a randomized clinical trial. J Clin Endocrinol Metab 87:3609–3617CrossRefPubMedGoogle Scholar
  32. 32.
    Freedman AN, Yu B, Gail MH et al (2011) Benefit/Risk assessment for breast cancer chemoprevention with raloxifene or tamoxifen for women age 50 years or older. J Clin Oncol 29:2327–2333CrossRefPubMedGoogle Scholar
  33. 33.
    Hadji P, Ziller M, Albert US et al (2010) Assessment of fracture risk in women with breast cancer using current vs emerging guidelines. Br J Cancer 102:645–650CrossRefPubMedGoogle Scholar
  34. 34.
    Kanis JA, McCloskey EV, Powles T et al (1999) A high incidence of vertebral fracture in women with breast cancer. Br J Cancer 79:1179–1181CrossRefPubMedGoogle Scholar
  35. 35.
    Edwards SA, Chiarelli AM, Ritvo P et al (2011) Satisfaction with initial screen and compliance with biennial breast screening at centers with and without nurses. Cancer Nurs 34:293–301CrossRefPubMedGoogle Scholar
  36. 36.
    Cummings SR, Black DM, Thompson DE et al (1998) Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 280:2077–2082CrossRefPubMedGoogle Scholar
  37. 37.
    Ensrud KE, Black DM, Palermo L et al (1997) Treatment with alendronate prevents fractures in women at highest risk: results from the Fracture Intervention Trial. Arch Intern Med 157:2617–2624CrossRefPubMedGoogle Scholar
  38. 38.
    Reginster J, Minne HW, Sorensen OH et al (2000) Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporos Int 11:83–91CrossRefPubMedGoogle Scholar
  39. 39.
    Ettinger B, Black DM, Mitlak BH et al (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 282:637–645CrossRefPubMedGoogle Scholar
  40. 40.
    Howell A, Cuzick J, Baum M et al (2005) Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years' adjuvant treatment for breast cancer. Lancet 365:60–62CrossRefPubMedGoogle Scholar
  41. 41.
    Eastell R, Adams J, Clack G et al (2011) Long-term effects of anastrozole on bone mineral density: 7-year results from the ATAC trial. Ann Oncol 22:857–862CrossRefPubMedGoogle Scholar
  42. 42.
    Joerger M, Thürlimann B (2009) Update of the BIG 1-98 Trial: where do we stand? Breast 18:S78–S82CrossRefPubMedGoogle Scholar
  43. 43.
    Rabaglio M, Sun Z, Price KN et al (2009) Bone fractures among postmenopausal patients with endocrine-responsive early breast cancer treated with 5 years of letrozole or tamoxifen in the BIG 1-98 trial. Ann Oncol 20:1489–1498CrossRefPubMedGoogle Scholar
  44. 44.
    Coombes RC, Hall E, Gibson LJ (2004) A randomized trial of exemestane after two to three years of tamoxifen therapy in postmenopausal women with primary breast cancer. N Engl J Med 350:1081–1092CrossRefPubMedGoogle Scholar
  45. 45.
    Goss PE, Strasser-Weippl K (2004) Prevention strategies with aromatase inhibitors. Clin Cancer Res 10:372S–379SCrossRefPubMedGoogle Scholar
  46. 46.
    Coleman RE, Banks LM, Girgis SI (2010) Reversal of skeletal effects of endocrine treatments in the Intergroup Exemestane Study. Breast Cancer Res Treat 124:153–161CrossRefPubMedGoogle Scholar
  47. 47.
    Chien AJ, Goss PE (2006) Aromatase inhibitors and bone health in women with breast cancer. J Clin Oncol 24:5305–5312CrossRefPubMedGoogle Scholar
  48. 48.
    Jakesz R, Jonat W, Gnant M et al (2005) Switching of postmenopausal women with endocrine-responsive early breast cancer to anastrozole after 2 years' adjuvant tamoxifen: combined results of ABCSG trial 8 and ARNO 95 trial. Lancet 366:455–462CrossRefPubMedGoogle Scholar
  49. 49.
    Cummings SR, Duong T, Kenyon E et al (2002) Serum estradiol level and risk of breast cancer during treatment with raloxifene. JAMA 287:216–220CrossRefPubMedGoogle Scholar
  50. 50.
    Prentice AM (2008) Vitamin D deficiency: a global perspective. Nutr Rev 66:S153–S164CrossRefPubMedGoogle Scholar
  51. 51.
    Mithal A, Wahl DA, Bonjour JP et al (2009) Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 20:1807–1820CrossRefPubMedGoogle Scholar
  52. 52.
    Bertoldo F, Pancheri S, Zenari S et al (2010) Emerging drugs for the management of cancer treatment induced bone loss. Expert Opin Emerg Drugs 15:323–342CrossRefPubMedGoogle Scholar
  53. 53.
    Bischoff-Ferrari HA, Shao A, Dawson-Hughes B et al (2010) Benefit-risk assessment of vitamin D supplementation. Osteoporos Int 21:1121–1132CrossRefPubMedGoogle Scholar
  54. 54.
    Peterlik M, Grant WB, Cross HS et al (2007) Calcium, vitamin D and cancer. Anticancer Res 29:3687–3698Google Scholar
  55. 55.
    Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281CrossRefPubMedGoogle Scholar
  56. 56.
    Adami S, Giannini S, Bianchi G et al (2009) Vitamin D status and response to treatment in post-menopausal osteoporosis. Osteoporos Int 20:239–244CrossRefPubMedGoogle Scholar
  57. 57.
    Bischoff-Ferrari HA, Willett WC, Wong JB (2009) Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med 169:551–561CrossRefPubMedGoogle Scholar
  58. 58.
    Chen P, Hu P, Xie D et al (2010) Meta-analysis of vitamin D, calcium and the prevention of breast cancer. Breast Cancer Res Treat 121:469–477CrossRefPubMedGoogle Scholar
  59. 59.
    Lazzeroni M, Gandini S, Puntoni M et al (2011) The science behind vitamins and natural compounds for breast cancer prevention. Getting the most prevention out of it. Breast 20(Suppl 3):S36-41Google Scholar
  60. 60.
    Garland CF, Comstock GW, Garland FC et al (1989) Serum 25-hydroxyvitamin D and colon cancer: eight-year prospective study. Lancet 2:1176–1178CrossRefPubMedGoogle Scholar
  61. 61.
    Tuohimaa P, Tenkanen L, Ahonen M et al (2004) Both high and low levels of blood vitamin D are associated with a higher prostate cancer risk: a longitudinal, nested case-control study in the Nordic countries. Int J Cancer 108:104–108CrossRefPubMedGoogle Scholar
  62. 62.
    Servitja S, Nogués X, Prieto-Alhambra D et al, Bone health in a prospective cohort of postmenopausal women receiving aromatase inhibitors for early breast cancer. Breast. 2011 Sep 15. [Epub ahead of print]Google Scholar
  63. 63.
    Prieto-Alhambra D, Javaid MK, Servitja S et al (2011 Feb) Vitamin D threshold to prevent aromatase inhibitor-induced arthralgia: a prospective cohort study. Breast Cancer Res Treat 125(3):869–878Google Scholar
  64. 64.
    Holick MF, Binkley NC, Bischoff-Ferrari HA et al (2011) Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. [Epub ahead of print].Google Scholar
  65. 65.
    Brufsky A, Bossermann L, Caradonna R et al (2009) Zoledronic acid effectively prevents aromatase inhibitor-associated bone loss in postmenopausal women with early breast cancer receiving adjuvant letrozole: the Z-FAST study 36 months follow-up results. Clin Breast Cancer 9(2):77–85CrossRefPubMedGoogle Scholar
  66. 66.
    Bundred NJ, Campbell ID, Davidson N et al (2008) Effective inhibition of aromatase inhibitor-associated bone loss by zoledronic acid in postmenopausal women receiving adjuvant letrozole: the ZO-FAST study results. Cancer 112:1001–1010CrossRefPubMedGoogle Scholar
  67. 67.
    Eidtmann H, de Boer R, Bundred N (2010) Efficacy of zoledronic acid in postmenopausal women with early breast cancer receiving adjuvant letrozole: 36-month results of the ZO-FAST Study. Ann Oncol 21:2188–2194CrossRefPubMedGoogle Scholar
  68. 68.
    De Boer R, Eidtmann H, Lluch A et al (2007) The ZO-FAST trial: zoledronic acid effectively inhibits aromatase inhibitor associated bone loss in post-menopausal women with early breast cancer receiving adjuvant letrozole: 24 month BMD results. Breast Cancer Res Treat 106:S501Google Scholar
  69. 69.
    Brufsky A, Bundred N, Coleman R et al (2008) Integrated analysis of zoledronic acid for prevention of aromatase inhibitor-associated bone loss in postmenopausal women with early breast cancer receiving adjuvant letrozole. Oncologist 13:503–514CrossRefPubMedGoogle Scholar
  70. 70.
    De Boer RH, Bundred N, Eidtmann H et al (2010) The effect of zoledronic acid on aromatase inhibitor-associated bone loss in postmenopausal women with early breast cancer receiving adjuvant letrozole: the ZO-FAST study 5-year final follow-up. Poster presented at: the 2010 San Antonio Breast Cancer Symposium; December 11, 2010; San Antonio, TexasGoogle Scholar
  71. 71.
    Gnant MF, Mlineritsch B, Luschin-Ebengreuth G et al (2007) Zoledronic acid prevents cancer treatment-induced bone loss in premenopausal women receiving adjuvant endocrine therapy for hormone-responsive breast cancer: a report from the Austrian Breast and Colorectal Cancer Study Group. J Clin Oncol 25:820–828CrossRefPubMedGoogle Scholar
  72. 72.
    Gnant M, Mlineritsch B, Stoeger H et al (2011) Adjuvant endocrine therapy plus zoledronic acid in premenopausal women with early-stage breast cancer: 62-month follow-up from the ABCSG-12 randomised trial. Lancet Oncol 12:631–641CrossRefPubMedGoogle Scholar
  73. 73.
    Gnant M, Mlineritsch B, Luschin-Ebengreuth G et al (2008) Adjuvant endocrine therapy plus zoledronic acid in premenopausal women with early-stage breast cancer: 5-year follow-up of the ABCSG-12 bone-mineral density substudy. Lancet Oncol 9:840–849CrossRefPubMedGoogle Scholar
  74. 74.
    Gnant M, Mlineritsch B, Schippinger W et al (2009) Endocrine therapy plus zoledronic acid in premenopausal breast cancer. N Engl J Med 360:679–691CrossRefPubMedGoogle Scholar
  75. 75.
    Coleman RE, Marshall M et al (2011) Breast Cancer Adjuvant Therapy with Zoledronic Acid. N Engl J Med 365(15):1396–1405CrossRefPubMedGoogle Scholar
  76. 76.
    Lester JE, Dodwell D, Purohit OP et al (2008) Prevention of anastrozole induced bone loss with monthly oral ibandronate during adjuvant aromatase inhibitor therapy for breast cancer. Clin Cancer Res 14:6336–6342CrossRefPubMedGoogle Scholar
  77. 77.
    Eastell R, Van Poznak CH, Hannon RA et al (2007) The SABRE study (Study of Anastrozole with the Bisphosphonate RisedronatE): 12 month analysis. J Bone Miner Res 22:S113CrossRefGoogle Scholar
  78. 78.
    Hines SL, Mincey BA, Sloan JA (2009) Phase III randomized, placebo-controlled, double-blind trial of risedronate for the prevention of bone loss in premenopausal women undergoing chemotherapy for primary breast cancer. J Clin Oncol 27(7):1047–1053, Epub 2008 Dec 15CrossRefPubMedGoogle Scholar
  79. 79.
    Saarto T, Bloqvist C, Valimaki M et al (1997) Clodronate improbe bone mineral density in postmenopausal breast cancer patients treated with adjuvant antioestrogen. Br Cancer 75:602–605CrossRefGoogle Scholar
  80. 80.
    Paterson AHG (2006) The role of bisphosphonates in early breast cancer. Oncologist 11:S13–S19CrossRefGoogle Scholar
  81. 81.
    Van den Wyngaert T, Huizing MT, Fossion E et al (2009) Bisphosphonates in oncology: rising stars or fallen heroes. Oncologist 14:181–191CrossRefPubMedGoogle Scholar
  82. 82.
    Ellis GK, Bone HG, Chlebowski R et al (2009) Effect of denosumab on bone mineral density in women receiving adjuvant aromatase inhibitors for non-metastatic breast cancer: subgroup analyses of a phase 3 study. Breast Cancer Res Treat 118:81–87CrossRefPubMedGoogle Scholar
  83. 83.
    Hillner B, Ingle J, Berenson J et al (2003) American Society of Clinical Oncology 2003 update on the role of bisphosphonates and bone health issues in breast cancer. J Clin Oncol 21:4042–4057CrossRefPubMedGoogle Scholar
  84. 84.
    Hadji P, Body JJ, Aapro MS et al (2008) Practical guidance for the management of aromatase inhibitor- associated bone loss. Ann Oncol 19:1407–1416CrossRefPubMedGoogle Scholar
  85. 85.
    Hadji P, Aapro MS, Body JJ et al (2011) Management of aromatase inhibitor-associated bone loss in postmenopausal women with breast cancer: practical guidance for prevention and treatment. Ann Oncol. [Epub ahead of print]Google Scholar
  86. 86.
    Body JJ, Bergmann P, Boonen S et al (2007) Management of cancer treatment-induced bone loss in early breast and prostate cancer – a consensus paper of the Belgian bone club. Osteoporos Int 18:1439–1450CrossRefPubMedGoogle Scholar
  87. 87.
    Reid DM, Doughty J, Eastell R et al (2008) Guidance for the management of breast cancer treatment-induced bone loss: a consensus position statement from a UK Expert Group. Cancer Treat Rev 34:S3–S18CrossRefPubMedGoogle Scholar
  88. 88.
    Kanis JA, Johnell O, Oden A et al (2008) FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397CrossRefPubMedGoogle Scholar
  89. 89.
    Donaldson MG, Palermo L, Schousboe JT et al (2009) FRAX and risk of vertebral fractures: the fracture intervention trial. J Bone Miner Res 24:1793–1799CrossRefPubMedGoogle Scholar
  90. 90.
    Body JJ (2011) New developments for treatment and prevention of bone metastases. Curr Opin Oncol 23:338–342CrossRefPubMedGoogle Scholar
  91. 91.
    Singh S, Cuzick J, Edwards R et al. Effect of anastrozole on bone mineral density after one year of treatment. Results from bone sub-study of the International Breast Cancer Intervention Study (IBIS-II). Breast Cancer Res Treat 2007; 106(Suppl 1: S9 Abstr 28).Google Scholar
  92. 92.
    Confavreux CB, Fontana A, Guastalla JP et al., Estrogen-dependent increase in bone turnover and bone loss in postmenopausal women with breast cancer treated with anastrozole. Prevention with bisphosphonates, Bone. 2007 Sep;41(3):346-52. Epub 2007 Jun 16.Google Scholar
  93. 93.
    Greenspan SL, Brufsky A, Lembersky BC (2008) Risedronate prevents bone loss in breast cancer, survivors: a 2-year, randomized, double-blind, placebocontrolled clinical trial. J Clin Oncol 26(16):2644–2652, Epub 2008 Apr 21CrossRefPubMedGoogle Scholar
  94. 94.
    Markopoulos C, Tzoracoleftherakis E, Polychronis A et al (2010) Management of anastrozole-induced bone loss in breast cancer patients with oral risedronate: results from the ARBI prospective clinical trial. Breast Cancer Res 12((2):R24, Epub 2010 Apr 16CrossRefGoogle Scholar
  95. 95.
    Van Poznak C, Hannon RA, Mackey JR (2010) Prevention of aromatase inhibitor-induced bone loss using risedronate: the SABRE trial. J Clin Oncol 28(6):967–975CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • R. Rizzoli
    • 1
  • J. J. Body
    • 2
  • A. De Censi
    • 3
    • 4
  • J. Y. Reginster
    • 5
  • P. Piscitelli
    • 6
  • M. L. Brandi
    • 6
  • on behalf of the European Society for Clinical and Economical aspects of Osteoporosis and Osteoarthritis (ESCEO)
  1. 1.Division of Bone DiseasesGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
  2. 2.Department of Medicine, CHU BrugmannUniversité Libre de BruxellesBrusselsBelgium
  3. 3.Division of Medical OncologyGalliera HospitalGenoaItaly
  4. 4.Division of Cancer Prevention and GeneticsEuropean Institute of OncologyMilanItaly
  5. 5.Department of Public Health ScienceUniversity of LiègeLiègeBelgium
  6. 6.Department of Internal MedicineUniversity of FlorenceFlorenceItaly

Personalised recommendations