Prevention and treatment of osteoporosis in postmenopausal women with estrogen receptor-positive breast cancer receiving aromatase inhibitors
Abstract
Aromatase inhibitors (AIs) are the preferred therapy for postmenopausal women with estrogen receptor-positive breast cancers. However, their long-term use causes bone loss and increased risks of osteoporosis and fractures.
With increased breast cancer survival, recognition of survivorship care issues, including bone health, has become more compelling than ever before. The recommendations for the prevention of osteoporosis and fracture include lifestyle recommendations, calcium and vitamin D supplementation.
Bisphosphonates (BP) have been shown in several phase III trials to prevent the bone loss induced by cancer treatment, although no fracture date are available. BP treatment is covered by public insurance policy only for patients diagnosed with osteoporosis or prevalent osteoporotic fracture.
Given the longterm nature of AI treatment with rapidly diminishing BMD, which can lead all the way to serious fractures, select current recommendations guide to start the BP treatment for women with a T-score <-2,0 or those with two or more clinical risk factors. The anti-RANK ligand antibody denosumab is also emerging as a adjuvant therapeutic option to prevent AI-induced bone loss and extend the time to first fracture in postmenopausal women treated with AIs.