Changes in bone mineral density in women with breast cancer receiving aromatase inhibitor therapy
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We assessed bone mineral density (BMD) change with aromatase inhibitor (AI) treatment in a contemporary cohort of women with breast cancer treated in Kaiser Permanente Northern California.
Percent and estimated annual percent changes in BMD at the total hip and lumbar spine were examined in 676 women receiving AI therapy who had two serial BMD reports available (at least 1 year apart) before and after AI initiation (N = 317) or during continued AI therapy (N = 359). BMD changes were examined at the total hip and lumbar spine and compared by age and clinical subgroups.
Women experienced BMD declines after AI initiation or continued therapy, with median annual percent change − 1.2% (interquartile range, IQR − 2.4 to − 0.1%) at the hip and − 1.0% (IQR − 2.3 to 0.1%) at the spine after AI initiation, and − 1.1% (IQR − 2.4 to 0.1%) at the hip and − 0.9% (IQR − 2.4 to 0.5%) at the spine during continued therapy. Higher levels of bone loss were observed among younger (< 55 years) compared with older (≥ 75 years) women at the hip (− 1.6% vs. − 0.8%) and at the spine (− 1.5% vs. − 0.5%) after AI initiation, and at the hip (− 1.4% vs. − 1.2%) and at the spine (− 2.4% vs. − 0.001%) during continued therapy.
Small but consistent declines in total hip and lumbar spine BMD were present in breast cancer patients following AI therapy initiation or continued AI therapy. Although the overall rates of osteoporosis were low, greater estimated levels of annual bone loss were evident among women < 55 years.
KeywordsBreast cancer Bone mineral density Aromatase inhibitor Endocrine therapy Osteoporosis
Bone mineral density
Body mass index
We thank Jean Lee for her medical record reviews. This study was funded by the National Cancer Institute R01 CA166701, R01 CA105274, and U01 CA195565.
Compliance with ethical standards
Conflict of interest
Dr. Lo or a household member has received research funding from Amgen, Sanofi, Novartis, GlaxoSmithKline, or AstraZeneca unrelated to this study. The other authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 1.Burstein HJ, Prestrud AA, Seidenfeld J, Anderson H, Buchholz TA, Davidson NE, Gelmon KE, Giordano SH, Hudis CA, Malin J, Mamounas EP, Rowden D, Solky AJ, Sowers MR, Stearns V, Winer EP, Somerfield MR, Griggs JJ, American Society of Clinical O (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(23):3784–3796. https://doi.org/10.1200/jco.2009.26.3756 CrossRefPubMedPubMedCentralGoogle Scholar
- 2.Dowsett M, Cuzick J, Ingle J, Coates A, Forbes J, Bliss J, Buyse M, Baum M, Buzdar A, Colleoni M, Coombes C, Snowdon C, Gnant M, Jakesz R, Kaufmann M, Boccardo F, Godwin J, Davies C, Peto R (2010) Meta-analysis of breast cancer outcomes in adjuvant trials of aromatase inhibitors versus tamoxifen. J Clin Oncol 28(3):509–518. https://doi.org/10.1200/JCO.2009.23.1274 CrossRefPubMedGoogle Scholar
- 5.Liu M, Goss PE, Ingle JN, Kubo M, Furukawa Y, Batzler A, Jenkins GD, Carlson EE, Nakamura Y, Schaid DJ, Chapman JA, Shepherd LE, Ellis MJ, Khosla S, Wang L, Weinshilboum RM (2014) Aromatase inhibitor-associated bone fractures: a case-cohort GWAS and functional genomics. Mol Endocrinol 28(10):1740–1751. https://doi.org/10.1210/me.2014-1147 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Goss PE, Ingle JN, Pritchard KI, Robert NJ, Muss H, Gralow J, Gelmon K, Whelan T, Strasser-Weippl K, Rubin S, Sturtz K, Wolff AC, Winer E, Hudis C, Stopeck A, Beck JT, Kaur JS, Whelan K, Tu D, Parulekar WR (2016) Extending aromatase-inhibitor adjuvant therapy to 10 years. N Engl J Med 375(3):209–219. https://doi.org/10.1056/NEJMoa1604700 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Kwan ML, Lo JC, Tang L, Laurent CA, Roh JM, Chandra M, Hahn TE, Hong CC, Sucheston-Campbell L, Hershman DL, Quesenberry CP Jr, Ambrosone CB, Kushi LH, Yao S (2014) Bone health history in breast cancer patients on aromatase inhibitors. PLoS ONE 9(10):e111477. https://doi.org/10.1371/journal.pone.0111477 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Yao S, Zhang Y, Tang L, Roh JM, Laurent CA, Hong CC, Hahn T, Lo JC, Ambrosone CB, Kushi LH, Kwan ML (2017) Bone remodeling and regulating biomarkers in women at the time of breast cancer diagnosis. Breast Cancer Res Treat 161(3):501–513. https://doi.org/10.1007/s10549-016-4068-5 CrossRefPubMedGoogle Scholar
- 13.Hadji P, Aapro MS, Body JJ, Bundred NJ, Brufsky A, Coleman RE, Gnant M, Guise T, Lipton A (2011) Management of aromatase inhibitor-associated bone loss in postmenopausal women with breast cancer: practical guidance for prevention and treatment. Ann Oncol 22(12):2546–2555. https://doi.org/10.1093/annonc/mdr017 CrossRefPubMedGoogle Scholar
- 16.Gnant M, Mlineritsch B, Luschin-Ebengreuth G, Kainberger F, Kassmann H, Piswanger-Solkner JC, Seifert M, Ploner F, Menzel C, Dubsky P, Fitzal F, Bjelic-Radisic V, Steger G, Greil R, Marth C, Kubista E, Samonigg H, Wohlmuth P, Mittlbock M, Jakesz R, Austrian B, Colorectal Cancer Study 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(9):840–849. https://doi.org/10.1016/s1470-2045(08)70204-3 CrossRefPubMedGoogle Scholar