title: Morphometric vertebral fractures in breast cancer patients treated with adjuvant aromatase inhibitor therapy: A cross-sectional study.
abstract: The impact of long-term adjuvant therapy with aromatase inhibitors (AIs) on vertebral fracture (VF) risk is still unclear.
  
  
  
  In this cross-sectional study, we explored the prevalence and determinants of VFs in breast cancer (BC) patients before and during AI therapy. Each woman underwent a dual-energy X-ray absorptiometry (DXA) to evaluate bone mineral density (BMD) and identify VFs by a quantitative morphometric approach. Blood samples were collected to measure serum hormone and calcium levels.
  
  
  
  We consecutively included 263 postmenopausal women with hormone receptor-positive early BC. One-hundred-sixty-nine women were AI-naïve, and 94 were AI-treated. AI-treated patients had lower BMD at total hip (p=0.01) and lumbar spine (p=0.03), higher serum vitamin D (p<0.001) and parathyroid hormone (p=0.006) values as compared to AI-naïve patients. The prevalence of VFs was 18.9% in AI-naïve patients, and 31.2% in those assessed during AI therapy (odds ratio 1.90, 95% CI 1.1-3.5, p=0.03). In AI-naïve patients, VFs were associated with older age (p=0.002) and lower BMD values at femoral neck (p=0.04) and total hip (p=0.007), whereas VFs occurred without association with any parameter analyzed in AI-treated patients. In AI-treated group, the prevalence of VFs was not significantly different between patients with osteoporosis and those with normal BMD (36.7% vs. 20.0%; p=0.31).
  
  
  
  In women with early BC, AI therapy is associated with high prevalence of radiological VFs, which were shown to be independent of BMD values during the adjuvant treatment. These findings may be clinically relevant since they may lead to a change in management of AI-induced skeletal fragility. Specifically, the results of this study provide a rationale for performing a morphometric evaluation of VFs in all women undergoing treatment with AIs.
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili Hospital, Medical Oncology Unit, Brescia, Italy; Breast Unit, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Pedersini
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili Hospital, Medical Oncology Unit, Brescia, Italy; Breast Unit, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Monteverdi
authors.affiliation: Endocrine and Bone Unit, Department of Medicine, ASST "Carlo Poma", Mantova, Italy.
authors.forename: Gherardo
authors.initials: G
authors.lastname: Mazziotti
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili Hospital, Medical Oncology Unit, Brescia, Italy. Electronic address: vitoamoroso@alice.it.
authors.forename: Vito
authors.initials: V
authors.lastname: Amoroso
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili Hospital, Medical Oncology Unit, Brescia, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Roca
authors.affiliation: Department of Molecular and Translational Medicine, University of Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili Hospital, Radiology Unit, Brescia, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Maffezzoni
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili Hospital, Medical Oncology Unit, Brescia, Italy; Breast Unit, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Vassalli
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili Hospital, Medical Oncology Unit, Brescia, Italy; Breast Unit, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Rodella
authors.affiliation: Department of Molecular and Translational Medicine, University of Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili Hospital, Radiology Unit, Brescia, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Formenti
authors.affiliation: Endocrinology, San Raffaele Vita-Salute University, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Frara
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili Hospital, Radiology Unit, Brescia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Maroldi
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili Hospital, Medical Oncology Unit, Brescia, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Berruti
authors.affiliation: Breast Unit, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Edda
authors.initials: E
authors.lastname: Simoncini
authors.affiliation: Endocrinology, San Raffaele Vita-Salute University, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Giustina
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D047072:Aromatase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D016103:Spinal Fractures / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology*
chemical_list: D047072:Aromatase Inhibitors
keywords: Aromatase inhibitors; Breast cancer; Dual energy X-ray absorptiometry; Vertebral fractures; Vertebral morphometry