title: Postmenopausal Breast Cancer, Aromatase Inhibitors, and Bone Health: What the Surgeon Should Know.
abstract: Breast cancer, as the most common malignancy in women, remains a major public health issue despite countless advances across decades. Endocrine therapy is the cornerstone of treatment of the hormone-sensitive subtype of breast cancer. The use of aromatase inhibitors (AIs) in the postmenopausal women has extended the survival beyond that of Tamoxifen, but harbors a subset of side effects, most notably accelerated bone loss. This, however, does not occur in all women undergoing treatment. It is vital to identify susceptible patients early, to limit such events, employ early treatment thereof, or alter drug therapy. International trials on AIs, predominantly performed in North American and European females, provide little information on what to expect in women in developing countries. Here, surgeons often prescribe and manage endocrine therapy. The prescribing surgeon should be aware of the adverse effect of the endocrine therapy and be able to attend to side effects. This review highlights clinical and biochemical factors associated with decrease in bone mineral density in an, as yet, unidentified subgroup of postmenopausal women. In the era of personalized medical care, appropriate management of bone health by surgeons based on these factors becomes increasingly important.
authors.affiliation: Department Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, PO Box 19063, Tygerberg, 7505, South Africa. kbaatjes@sun.ac.za.
authors.forename: K J
authors.initials: KJ
authors.lastname: Baatjes
authors.affiliation: Department Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, PO Box 19063, Tygerberg, 7505, South Africa.
authors.forename: J P
authors.initials: JP
authors.lastname: Apffelstaedt
authors.affiliation: Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors.forename: M J
authors.initials: MJ
authors.lastname: Kotze
authors.affiliation: Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors.forename: M
authors.initials: M
authors.lastname: Conradie
mesh_terms: D000465:Algorithms; D047072:Aromatase Inhibitors / Q000009:adverse effects*; D015415:Biomarkers / Q000032:analysis; D001835:Body Weight; D015519:Bone Density / Q000187:drug effects; D016723:Bone Remodeling; D001943:Breast Neoplasms / Q000188:drug therapy*; D002983:Clinical Competence; D004198:Disease Susceptibility; D004965:Estrogen Antagonists / Q000627:therapeutic use; D004967:Estrogens / Q000502:physiology; D005260:Female; D006801:Humans; D009362:Neoplasm Metastasis / Q000517:prevention & control; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D015663:Osteoporosis, Postmenopausal / Q000209:etiology / Q000517:prevention & control*; D058866:Osteoporotic Fractures / Q000209:etiology / Q000517:prevention & control; D018570:Risk Assessment; D014808:Vitamin D Deficiency / Q000150:complications / Q000517:prevention & control
chemical_list: D047072:Aromatase Inhibitors; D015415:Biomarkers; D004965:Estrogen Antagonists; D004967:Estrogens