title: Change in bone mineral density during adjuvant chemotherapy for early-stage breast cancer.
abstract: Adjuvant chemotherapy has been associated with loss of bone mineral density (BMD) either as a direct effect or due to glucocorticoids used as supportive care medication. A prospective cohort study was conducted to evaluate changes in BMD from baseline to right after completion of chemotherapy, i.e., 4 months.
  
  
  
  Dual-imaging X-ray absorptiometry (DXA) was performed at baseline and after completing anthracycline- and taxane-based chemotherapy to measure BMD in the spine, hip, and forearm in early-stage breast cancer patients. High-dose prednisolone was used at three weekly intervals to reduce nausea and vomiting. Patients were advised a daily calcium/vitamin D supplement. Linear regression was used to assess mean percentage change in BMD and 95 % confidence intervals (95 % CI) according to doses of prednisolone, menopausal status, smoking, and BMI.
  
  
  
  Eight patients were excluded: seven because of initiation of bisphosphonate treatment due to osteoporosis at baseline, and one had non-interpretable DXA. The final cohort included 97 patients with a mean age of 53 years (range 34-72). Mean cumulative prednisolone dose was 1308 mg (95 % CI 1255; 1362). BMD increased 1.36 % (95 % CI 0.7; 2.0, p < 0.001) in the spine and 1.27 % (95 % CI 0.9; 1.7, p < 0.001) in the hip. Forearm BMD did not change. Postmenopausal women had increases in spine BMD of 2.35 % (95 % CI 1.1; 3.6, p < 0.001) compared to premenopausal women. The spine BMD of current smokers decreased 1.67 % (95 % CI -3.3; -0.1, p = 0.04) compared to never/former smokers.
  
  
  
  Adjuvant chemotherapy supplemented with prednisolone was not associated with loss of BMD. Postmenopausal women gained bone mass, whereas current smokers lost bone mass.
authors.affiliation: Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark. Carina.Oerts.Christensen@rsyd.dk.|Institute of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000, Odense C, Denmark. Carina.Oerts.Christensen@rsyd.dk.
authors.forename: Carina Ørts
authors.initials: CØ
authors.lastname: Christensen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Cronin-Fenton
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
authors.forename: Trine
authors.initials: T
authors.lastname: Frøslev
authors.affiliation: Institute of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000, Odense C, Denmark.|Department of Endocrinology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
authors.forename: Anne Pernille
authors.initials: AP
authors.lastname: Hermann
authors.affiliation: Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark.|Institute of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000, Odense C, Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Ewertz
mesh_terms: D000328:Adult; D000368:Aged; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010024:Osteoporosis / Q000188:drug therapy*
chemical_list: D050071:Bone Density Conservation Agents
keywords: Adjuvant chemotherapy; Bone mineral density; Breast cancer; Glucocorticoids; Osteoporosis