title: Zoledronic acid for treatment of osteopenia and osteoporosis in women with primary breast cancer undergoing adjuvant aromatase inhibitor therapy: a 5-year follow-up.
abstract: OBJECTIVE
  This study was designed to explore whether zoledronic acid could prevent expected loss of bone mineral density (BMD) in postmenopausal women with pre-existing osteopenia or osteoporosis who were initiating adjuvant letrozole therapy for primary breast cancer.
  
  
  METHODS
  Between June 2006 and July 2007, 60 postmenopausal women with estrogen and/or progesterone receptor-positive breast cancer and a BMD T-score ≤-2.0 were enrolled. Participants received letrozole 2.5 mg and vitamin D 400 IU daily, calcium 500 mg twice daily, and zoledronic acid 4 mg every 6 months for a maximum of 5 years or until disease progression. BMD at the lumbar spine and femoral neck was recorded at the start of the study and annually for 5 years. Patients were evaluated for fractures every 6 months for the duration of the trial.
  
  
  RESULTS
  After 5 years, mean BMD increased significantly by 11.6% (p = 0.01) at the lumbar spine and by 8.8% (p = 0.01) at combined sites. Femoral neck BMD increased by 4.2%, although this was not significant (p = 0.23). At the end of the trial, BMDs were consistent with osteoporosis in 7 % and osteopenia in 36% of the patients. A total of six fractures were reported after 417 individual assessments.
  
  
  CONCLUSIONS
  Zoledronic acid appears to prevent further bone loss in postmenopausal breast cancer patients with osteopenia and osteoporosis starting treatment with letrozole. These findings were maintained at 5 years and support concurrent initiation of bisphosphonate and aromatase inhibitor therapy in this high-risk population.
authors: Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. majithia.neil@mayo.edu.
authors: Neil
authors: N
authors: Majithia
authors: Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors: Pamela J
authors: PJ
authors: Atherton
authors: Department of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors: Jacqueline M
authors: JM
authors: Lafky
authors: Department of Medical Oncology, Washington University School of Medicine, 660 S. Euclid Ave, Box 8056, St Louis, MO, 63110, USA.
authors: Nina
authors: N
authors: Wagner-Johnston
authors: Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors: Janet
authors: J
authors: Olson
authors: Cancer Center of Kansas, 818 N. Emporia #403, Wichita, KS, 67214, USA.
authors: Shaker R
authors: SR
authors: Dakhil
authors: Department of Hematology and Oncology, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA.
authors: Edith A
authors: EA
authors: Perez
authors: Department of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors: Charles L
authors: CL
authors: Loprinzi
authors: Department of General Internal Medicine, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA.
authors: Stephanie L
authors: SL
authors: Hines
mesh_terms: D000277:Adjuvants, Pharmaceutic / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D047072:Aromatase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001851:Bone Diseases, Metabolic / Q000188:drug therapy / Q000517:prevention & control*; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D004164:Diphosphonates / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D000077289:Letrozole; D008159:Lumbar Vertebrae / Q000473:pathology; D008875:Middle Aged; D009570:Nitriles / Q000009:adverse effects* / Q000627:therapeutic use; D010024:Osteoporosis / Q000188:drug therapy / Q000517:prevention & control*; D014230:Triazoles / Q000009:adverse effects* / Q000627:therapeutic use; D000077211:Zoledronic Acid
chemical_list: D000277:Adjuvants, Pharmaceutic; D047072:Aromatase Inhibitors; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D009570:Nitriles; D014230:Triazoles; D000077211:Zoledronic Acid; D000077289:Letrozole
keywords: Breast cancer; Letrozole; Osteopenia; Osteoporosis; Zoledronic acid