title: Cancer treatment-induced bone loss in premenopausal women: a need for therapeutic intervention?
abstract: Current clinical treatment guidelines recommend cytotoxic chemotherapy, endocrine therapy, or both (with targeted therapy if indicated) for premenopausal women with early-stage breast cancer, depending on the biologic characteristics of the primary tumor. Some of these therapies can induce premature menopause or are specifically designed to suppress ovarian function and reduce circulating estrogen levels. In addition to bone loss associated with low estrogen levels, cytotoxic chemotherapy may have a direct negative effect on bone metabolism. As a result, cancer treatment-induced bone loss poses a significant threat to bone health in premenopausal women with breast cancer. Clinical trials of antiresorptive therapies, such as bisphosphonates, have demonstrated the ability to slow or prevent bone loss in this setting. Current fracture risk assessment tools are based on data from healthy postmenopausal women and do not adequately address the risks associated with breast cancer therapy, especially in younger premenopausal women. We therefore recommend that all premenopausal women with breast cancer be informed about the potential risk of bone loss prior to beginning anticancer therapy. Women who experience amenorrhea should have bone mineral density assessed by dual-energy X-ray absorptiometry and receive regular follow-up to monitor bone health. Regular exercise and daily calcium and vitamin D supplementation are recommended. Women with a Z-score <-2.0 or Z-score ≤-1.0 and/or a 5-10% annual decrease in bone mineral density should be considered for bisphosphonate therapy in addition to calcium and vitamin D supplements.
authors.affiliation: Department of Endocrinology, Philipps-University of Marburg, Universitätsklinikum Giessen und Marburg GmbH, Marburg, Baldingerstrasse, 35033 Marburg, Germany. hadji@med.uni-marburg.de
authors.forename: P
authors.initials: P
authors.lastname: Hadji
authors.forename: M
authors.initials: M
authors.lastname: Gnant
authors.forename: J J
authors.initials: JJ
authors.lastname: Body
authors.forename: N J
authors.initials: NJ
authors.lastname: Bundred
authors.forename: A
authors.initials: A
authors.lastname: Brufsky
authors.forename: R E
authors.initials: RE
authors.lastname: Coleman
authors.forename: T A
authors.initials: TA
authors.lastname: Guise
authors.forename: A
authors.initials: A
authors.lastname: Lipton
authors.forename: M S
authors.initials: MS
authors.lastname: Aapro
mesh_terms: D000568:Amenorrhea / Q000139:chemically induced / Q000453:epidemiology; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D005260:Female; D050723:Fractures, Bone / Q000209:etiology; D006801:Humans; D015994:Incidence; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D010024:Osteoporosis / Q000139:chemically induced* / Q000188:drug therapy* / Q000453:epidemiology; D017697:Premenopause; D018570:Risk Assessment
chemical_list: D000970:Antineoplastic Agents; D050071:Bone Density Conservation Agents