Women and bone health: maximizing the benefits of aromatase inhibitor therapy.
Postmenopausal women with early breast cancer (EBC) are already at risk for bone loss, osteoporosis and fracture as they age because of declining estrogen levels. Adjuvant hormonal therapy with aromatase inhibitors (AIs; e.g. letrozole, anastrozole, exemestane) can exacerbate this risk. All three AIs appear to have similar effects on bone, increasing bone turnover and fracture risk in postmenopausal women with EBC. Risk factors for bone loss can be used to assess fracture risk and the need for ongoing assessment and/or treatment in postmenopausal women receiving AIs for EBC. The concomitant, up-front use of intravenous bisphosphonate therapy, such as zoledronic acid, in combination with AIs can inhibit bone loss. In addition, a strong body of evidence suggests an anticancer activity of bisphosphonate therapy with zoledronic acid in EBC in both the pre- and postmenopausal adjuvant setting. Zoledronic acid thus provides a therapeutic option for postmenopausal women with EBC who may be at higher risk for bone loss while on AIs, allowing more patients to receive treatment with effective adjuvant hormonal therapy to prevent recurrence.
Martha Bacon Stimpson Endowed Chair in Medical Oncology, Virginia Piper Cancer Institute and Minnesota Oncology, Minneapolis, Minn 55407, USA. shou-ching.tang@allina.com
Shou-Ching
SC
Tang
D000077384:Anastrozole; D000730:Androstadienes / Q000009:adverse effects; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects*; D047072:Aromatase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D016723:Bone Remodeling / Q000187:drug effects; D001943:Breast Neoplasms / Q000188:drug therapy*; D015179:Colorectal Neoplasms / Q000188:drug therapy; D000069448:Denosumab; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D000077289:Letrozole; D009570:Nitriles / Q000009:adverse effects; D010024:Osteoporosis / Q000139:chemically induced* / Q000517:prevention & control*; D015663:Osteoporosis, Postmenopausal / Q000517:prevention & control; D053245:RANK Ligand / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D013629:Tamoxifen / Q000627:therapeutic use; D014230:Triazoles / Q000009:adverse effects; D000077211:Zoledronic Acid
D000730:Androstadienes; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D009570:Nitriles; D053245:RANK Ligand; D014230:Triazoles; D013629:Tamoxifen; D000077384:Anastrozole; D000069448:Denosumab; D000077211:Zoledronic Acid; D000077289:Letrozole; C056516:exemestane