title: Fracture incidence after 3 years of aromatase inhibitor therapy.
abstract: BACKGROUND
  The purpose of this study was to describe the fracture incidence and bone mineral density (BMD) evolution in a large cohort of post-menopausal women with breast cancer after 3 years of aromatase inhibitor (AI) therapy.
  
  
  METHODS
  A prospective, longitudinal study in real-life setting. Each woman had an extensive medical assessment, a biological evaluation, a BMD measurement, and systematic spinal X-rays at baseline and after 3 years of AI therapy. Women with osteoporosis at baseline (T-score < -2.5 and/or non-traumatic fracture history) were treated by oral weekly bisphosphonates.
  
  
  RESULTS
  Among 497 women (mean age 63.8 ± 9.6 years) included in this study, 389 had a bone evaluation both at baseline and after 3 years of AI therapy: 267 women (mean age 61.2 ± 8.6) with no osteoporosis at baseline and 122 women (mean age 67.2 ± 9.1) with osteoporosis at baseline justifying a weekly oral bisphosphonate treatment. Women without bisphosphonates had a significant decrease in spine BMD (-3.5%, P < 0.01), neck BMD (-2.0%, P < 0.01), and total hip BMD (-2.1%, P < 0.01) over the 3 years but only 15 of them (5.6%) presented an incident vertebral or non-vertebral fracture. In osteoporotic women treated with bisphosphonates, spine and hip BMD were maintained at 3 years but 12 of them (9.8%) had an incident fracture. These fractured women were significantly older (74.1 ± 9.8 versus 66.5 ± 8.8) but also presented BMD loss during treatment suggesting poor adherence to bisphosphonate treatment.
  
  
  CONCLUSIONS
  This real-life study confirmed that AIs induced moderate bone loss and low fracture incidence in post-menopausal women without initial osteoporosis. In women with baseline osteoporosis and AI therapy, oral bisphosphonates maintain BMD but were associated with a persistent fracture risk, particularly in older women.
authors.affiliation: Department of Rheumatology; Research Group on Bone Remodeling and BioMaterials, UPRES EA 4658, University Hospital, Angers. Electronic address: bebouvard@chu-angers.fr.
authors.forename: B
authors.initials: B
authors.lastname: Bouvard
authors.affiliation: Paul Papin Cancer Institute, ICO, Angers, France.
authors.forename: P
authors.initials: P
authors.lastname: Soulié
authors.affiliation: Department of Rheumatology; Research Group on Bone Remodeling and BioMaterials, UPRES EA 4658, University Hospital, Angers.
authors.forename: E
authors.initials: E
authors.lastname: Hoppé
authors.affiliation: Paul Papin Cancer Institute, ICO, Angers, France.
authors.forename: M
authors.initials: M
authors.lastname: Georgin-Mege
authors.affiliation: Department of Rheumatology; Research Group on Bone Remodeling and BioMaterials, UPRES EA 4658, University Hospital, Angers.
authors.forename: M
authors.initials: M
authors.lastname: Royer
authors.affiliation: Paul Papin Cancer Institute, ICO, Angers, France.
authors.forename: N
authors.initials: N
authors.lastname: Mesgouez-Nebout
authors.affiliation: Department of Rheumatology.
authors.forename: C
authors.initials: C
authors.lastname: Lassalle
authors.affiliation: Paul Papin Cancer Institute, ICO, Angers, France.
authors.forename: P
authors.initials: P
authors.lastname: Cellier
authors.affiliation: Paul Papin Cancer Institute, ICO, Angers, France.
authors.forename: E
authors.initials: E
authors.lastname: Jadaud
authors.affiliation: Paul Papin Cancer Institute, ICO, Angers, France.
authors.forename: S
authors.initials: S
authors.lastname: Abadie-Lacourtoisie
authors.affiliation: Paul Papin Cancer Institute, ICO, Angers, France.
authors.forename: C
authors.initials: C
authors.lastname: Tuchais
authors.affiliation: Paul Papin Cancer Institute, ICO, Angers, France.
authors.forename: S
authors.initials: S
authors.lastname: Vinchon-Petit
authors.affiliation: Department of Rheumatology; Research Group on Bone Remodeling and BioMaterials, UPRES EA 4658, University Hospital, Angers.
authors.forename: M
authors.initials: M
authors.lastname: Audran
authors.affiliation: Research Group on Bone Remodeling and BioMaterials, UPRES EA 4658, University Hospital, Angers.
authors.forename: D
authors.initials: D
authors.lastname: Chappard
authors.affiliation: Department of Rheumatology; Research Group on Bone Remodeling and BioMaterials, UPRES EA 4658, University Hospital, Angers.
authors.forename: E
authors.initials: E
authors.lastname: Legrand
mesh_terms: D000367:Age Factors; D000368:Aged; D047072:Aromatase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D015519:Bone Density; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced* / Q000150:complications / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause / Q000187:drug effects
chemical_list: D047072:Aromatase Inhibitors
keywords: aromatase inhibitor; bisphosphonate; breast cancer; osteoporosis; vertebral fracture