Skeletal events of Anastrozole versus Tamoxifen on bone mineral density and bone biomarker osteocalcin in postmenopausal women with early breast cancer
- 42 Downloads
Postmenopausal women with breast cancer are at increased risk of bone loss because of age related estrogen deficiency face which accelerated with the use of aromatase inhibitors (AIs). We aimed to study the effect on bone mineral density (BMD) and bone formation biomarker osteocalcin level in postmenopausal breast cancer patients, for the first three years of adjuvant hormonal treatment of both groups Tamoxifen versus Anastrozol.
One-hundered postmenopausal breast cancers were prospectively randomized to receive either Tamoxifen 20 mg/day (n = 50) or Anastrozole 10 mg (n = 50). Both BMD and osteocalcin were assessed initially before treatment and then at regular intervals for both groups.
Use of Tamoxifen was associated with significant annual decrease in osteocalcin (P = 0.001), whereas Anastrozole group had gradual increase of the annual levels (P < 0.01). BMD decreased significantly in Anastrozole versus Tamoxifen groups (2.6% vs. 0.4%, P < 0.001). Osteoporosis T < −2.5 was reported significantly higher in Anastrozole group (P < 0.01). Women with initial osteopenia in Anastrozole group showed significant decrease in BMD (P < 0.05). The addition of bisphosphonate for patients with early osteoporosis markedly improved both osteocalcin level and BMD.
Tamoxifen preserves BMD in postmenopausal breast cancer patients, whereas Anastrozole accelerates age associated fall in BMD especially in the first year of therapy, moreover, the addition of bisphosphonate can help to decrease the skeletal related events associated with treatment to ensure better quality of life with treatment.
Key wordsAnastrozole Tamoxifen, bone mineral density (BMD) breast cancer osteocalcin
Unable to display preview. Download preview PDF.
- 1.Geisler J, Haynes B, Anker G, et al. Influence of letrozole (Femara) and Anastrozole (Arimidex) on total body aromatization and plasma estrogen levels in postmenopausal breast cancer patients evaluated in a randomized, cross-over-designed study. J Clin Oncol, 2002, 20: 751–757.CrossRefPubMedGoogle Scholar
- 3.Mouridsen H, Gershanovich M, Sun Y, et al. Phase III study of letrozole versus Tamoxifen as first-line therapy of advanced breast cancer in postmenopausal women: analysis of survival and update of efficacy from the international letrozole breast cancer group. J Clin Oncol, 2003, 21: 2101–2109.CrossRefPubMedGoogle Scholar
- 14.Winer EP, Hudis C, Burstein HJ, et al. American society of clinical oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with hormone receptor-positive breast cancer: status report. J Clin Oncol, 2005, 23: 619–629.CrossRefPubMedGoogle Scholar
- 17.Coleman RE. Effect of Anastrozole on bone mineral density: 5-year results from the Arimidex Tamoxifen Alone or in Combination (ATAC) trial. J Clin Oncol, 2006, 24: 5s.Google Scholar
- 20.Brufsky AHW, Beck J. Zoledronic acid (ZA) effectively inhibits cancer treatment-induced bone loss (CITBL) in postmenopausal women (PMW) with early breast cancer (BCa) receiving adjuvant letrozole: 12 month BMD results of the Z-FAST trial. J Clin Oncol, 2005, 23: 12s.Google Scholar
- 21.World Health Organization. Assessment of fracture risk and application to screening for postmenopausal osteoporosis. Geneva, Switzerland, World Health Organization 1994.Google Scholar
- 22.Baum M, Budzar AU, Cuzick J, et al. ATAC Trialists’ Group: Anasatrozole alone or in combination with Tamoxifen versus Tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer — first results of the ATAC randomized trial. Lancet, 2002, 359: 2131–2139.CrossRefPubMedGoogle Scholar
- 31.Howell A, Forbes J, Cuzick J, et al. Initial adjuvant therapy with Anastrozole — early and late event data from the Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial in the hormone-responsive population. St Gallen, 2009 Poster.Google Scholar
- 34.Mincey BA, Duh MS, Thomas SK, et al. Risk of cancer treatment-associated bone loss and fractures among women with breast cancer receiving aromatase inhibitors. J Clin Oncol, 2006, 24: 17s.Google Scholar