title: Vitamin D deficiency and bone mineral density in postmenopausal women receiving aromatase inhibitors for early breast cancer.
abstract: OBJECTIVE
  Aromatase inhibitors (AI) treatment leads to an increased risk of bone loss and fractures. In a group of women with early breast cancer (EBC) and baseline Vitamin D deficiency (<30 ng/ml) who are treated with AI, we aim to describe: serum levels of Vitamin D, bone mineral density (BMD), calcium intake, and the increase of serum 25(OH)D accomplished in 3 months of treatment with Vitamin D supplements.
  
  
  METHODS
  Prospective, non-randomized clinical trial.
  
  
  METHODS
  In 232 consecutively included women with EBC in treatment with AI, we assessed baseline calcium intake, serum levels of 25(OH)D, BMD and, spine X-ray. All received Calcium and Vitamin D supplements, and those with vitamin deficiency received 16,000 IU Vitamin D every 2 weeks. Serum levels of 25(OH)D were newly assessed after treatment. All the baseline evaluation was performed before starting AI treatment.
  
  
  RESULTS
  Mean age at baseline (+/-SD) was 63.2+/-8.8 years. In 150 (64.9%) cases, the women had been treated previously with tamoxifen; 101 (43.7%) started exemestane, 119 (51.5%) letrozole, and 11 (4.8%) anastrozole. The AI were initiated within 6 weeks after surgery or after the last cycle of chemotherapy. At baseline, 88.1% had 25(OH)D levels <30 ng/ml, 21.2% had severe deficiency (<10 ng/ml), and 25% of the participants had osteoporosis. Mean daily calcium intake was low (841+/-338). We found a significant association between 25(OH)D levels and BMD at baseline, which remained significant in femoral neck BMD after multivariate adjustment. Plasma 25(OH)D levels improved significantly at 3 months follow-up in those treated with high dose Vitamin D supplements: mean increase 32.55 ng/ml (95%CI 28.06-37.03).
  
  
  CONCLUSIONS
  Our study suggests a high prevalence of commonly unrecognized Vitamin D deficiency in women with EBC treated with AI, a known osteopenic agent. Our results support the need for a routine assessment of 25(OH)D levels and, when necessary, supplementation in these patients.
authors.affiliation: Internal Medicine Department, URFOA-IMIM, RETICEF, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain. xnogues@hospitaldelmar.cat
authors.forename: Xavier
authors.initials: X
authors.lastname: Nogues
authors.forename: Sonia
authors.initials: S
authors.lastname: Servitja
authors.forename: Maria Jesus
authors.initials: MJ
authors.lastname: Peña
authors.forename: Daniel
authors.initials: D
authors.lastname: Prieto-Alhambra
authors.forename: Rosa
authors.initials: R
authors.lastname: Nadal
authors.forename: Leonardo
authors.initials: L
authors.lastname: Mellibovsky
authors.forename: Joan
authors.initials: J
authors.lastname: Albanell
authors.forename: Adolfo
authors.initials: A
authors.lastname: Diez-Perez
authors.forename: Ignasi
authors.initials: I
authors.lastname: Tusquets
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D047072:Aromatase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects*; D001943:Breast Neoplasms / Q000150:complications* / Q000188:drug therapy; D002118:Calcium / Q000008:administration & dosage; D005260:Female; D005269:Femur; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D017698:Postmenopause; D011446:Prospective Studies; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood / Q000627:therapeutic use*; D014808:Vitamin D Deficiency / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents; D047072:Aromatase Inhibitors; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D002118:Calcium