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Birtolo MF, Pedersini R, Palermo A, Vena W, Morenghi E, Cristofolini G, Presciuttini B, Tabacco G, Naciu AM, Pigni S, Laganà M, Mazzoleni F, Cosentini D, Ciafardini A, Pagani M, Farina D, Balzarini L, Zambelli A, Torrisi R, Cianferotti L, Napoli N, Bossi AC, Lania AG, Berruti A, Mazziotti G. Bone-active drugs in premenopausal women with breast cancer under hormone-deprivation therapies. Eur J Endocrinol 2024; 191:117-125. [PMID: 39056237 DOI: 10.1093/ejendo/lvae086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/04/2024] [Accepted: 07/25/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Bone health management in premenopausal women with breast cancer (BC) under hormone-deprivation therapies (HDTs) is often challenging, and the effectiveness of bone-active drugs is still unknown. METHODS This retrospective multicenter study included 306 premenopausal women with early BC undergoing HDTs. Bone mineral density (BMD) and morphometric vertebral fractures (VFs) were assessed 12 months after HDT initiation and then after at least 24 months. RESULTS After initial assessment, bone-active drugs were prescribed in 77.5% of women (151 denosumab 60 mg/6 months, 86 bisphosphonates). After 47.0 ± 20.1 months, new VFs were found in 16 women (5.2%). Vertebral fracture risk was significantly associated with obesity (odds ratio [OR] 3.87, P = .028), family history of hip fractures or VFs (OR 3.21, P = .040], chemotherapy-induced menopause (OR 6.48, P < .001), preexisting VFs (OR 25.36, P < .001), baseline T-score less than or equal to -2.5 standard deviation (SD) at any skeletal site (OR 4.14, P = .036), and changes at lumbar and total hip BMD (OR 0.94, P = .038 and OR 0.88, P < .001, respectively). New VFs occurred more frequently in women untreated compared to those treated with bone-active drugs (14/69, 20.8% vs 2/237, 0.8%; P < .001) and the anti-fracture effectiveness remained significant after correction for BMI (OR 0.03; P < .001), family history of fractures (OR 0.03; P < .001), chemotherapy-induced menopause (OR 0.04; P < .001), and preexisting VFs (OR 0.01; P < .001). CONCLUSIONS Premenopausal women under HDTs are at high risk of VFs in relationship with high BMI, densitometric diagnosis of osteoporosis, preexisting VFs, and family history of osteoporotic fractures. Vertebral fractures in this setting might be effectively prevented by bisphosphonates or denosumab.
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Affiliation(s)
- Maria Francesca Birtolo
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele-Milan, Italy
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano-Milan, Italy
| | - Rebecca Pedersini
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, 25123 Brescia, Italy
| | - Andrea Palermo
- Unit of Metabolic Bone and Thyroid Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Walter Vena
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele-Milan, Italy
- Diabetology and Endocrinology, Humanitas Gavazzeni, 24125 Bergamo, Italy
| | - Emanuela Morenghi
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele-Milan, Italy
- Biostatistics Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano-Milan, Italy
| | - Giacomo Cristofolini
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele-Milan, Italy
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano-Milan, Italy
| | - Barbara Presciuttini
- Endocrinology Unit, Department of Medicine, ASST Carlo Poma, 46100 Mantua, Italy
| | - Gaia Tabacco
- Unit of Metabolic Bone and Thyroid Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Anda Mihaela Naciu
- Unit of Metabolic Bone and Thyroid Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Stella Pigni
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele-Milan, Italy
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano-Milan, Italy
| | - Marta Laganà
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, 25123 Brescia, Italy
| | - Federica Mazzoleni
- Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Deborah Cosentini
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, 25123 Brescia, Italy
| | - Antea Ciafardini
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele-Milan, Italy
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano-Milan, Italy
| | - Mauro Pagani
- Endocrinology Unit, Department of Medicine, ASST Carlo Poma, 46100 Mantua, Italy
| | - Davide Farina
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Radiology, University of Brescia, ASST Spedali Civili, 25123 Brescia, Italy
| | - Luca Balzarini
- Department of Radiology, IRCCS Humanitas Research Hospital, 20089 Rozzano-Milan, Italy
| | - Alberto Zambelli
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele-Milan, Italy
- Cancer Center, IRCCS Humanitas Research Hospital, 20089 Rozzano-Milan, Italy
| | - Rosalba Torrisi
- Cancer Center, IRCCS Humanitas Research Hospital, 20089 Rozzano-Milan, Italy
| | - Luisella Cianferotti
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50134 Florence, Italy
| | - Nicola Napoli
- Unit of Metabolic Bone and Thyroid Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico di Roma, 00128 Rome, Italy
- Division of Bone and Mineral Diseases, Washington University in St Louis, St Louis, MO 63130, United States
| | - Antonio Carlo Bossi
- Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Andrea Gerardo Lania
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele-Milan, Italy
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano-Milan, Italy
| | - Alfredo Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, 25123 Brescia, Italy
| | - Gherardo Mazziotti
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele-Milan, Italy
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano-Milan, Italy
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Pedersini R, Schivardi G, Laini L, Zamparini M, Bonalumi A, di Mauro P, Bosio S, Amoroso V, Villa N, Alberti A, Di Meo N, Gonano C, Zanini B, Laganà M, Ippolito G, Rinaudo L, Farina D, Castellano M, Cappelli C, Simoncini EL, Cosentini D, Berruti A. Changes in body composition in early breast cancer patients treated with aromatase inhibitors. J Endocrinol Invest 2024:10.1007/s40618-024-02401-7. [PMID: 38856966 DOI: 10.1007/s40618-024-02401-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 05/20/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE The aim of the study was to analyze the modification of total and regional body composition in early breast cancer patients treated with aromatase inhibitors (AIs). METHODS This is a prospective, single-center, observational, longitudinal study. Four-hundred and twenty-eight patients treated with adjuvant aromatase inhibitors were enrolled at the Medical Oncology and Breast Unit of Spedali Civili Hospital in Brescia from September 2014 to June 2022. Several body composition parameters including total and regional fat and lean body mass were investigated with dual-energy X-ray absorptiometry (DXA) scan at baseline and after 18 months of treatment with aromatase inhibitors. RESULTS A significant increase in fat body mass (mean + 7.2%, 95% confidence interval [CI]: 5.5;8.9%) and a reduction in lean body mass (mean -3.1%, 95% CI -3.9; -2.4) were documented in this population. The changes in fat and lean body mass varied considerably according to different body districts ranging between + 3.2% to + 10.9% and from-1.3% to -3.9%, respectively. CONCLUSION Aromatase inhibitor adjuvant therapy in early breast cancer is associated with changes in body composition, with a wide variability among different body districts, leading to a risk of sarcopenic obesity. Supervised physical exercise that focuses on single body parts that may display detrimental variations may be beneficial for AIs treated patients.
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Affiliation(s)
- R Pedersini
- Medical Oncology Department, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 20123, Brescia, Italy
- SSVD Breast Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - G Schivardi
- Medical Oncology Department, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 20123, Brescia, Italy.
| | - L Laini
- Medical Oncology Department, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 20123, Brescia, Italy
| | - M Zamparini
- Medical Oncology Department, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 20123, Brescia, Italy
| | - A Bonalumi
- Medical Oncology Department, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 20123, Brescia, Italy
| | - P di Mauro
- Medical Oncology Department, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 20123, Brescia, Italy
| | - S Bosio
- SSVD Breast Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - V Amoroso
- Medical Oncology Department, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 20123, Brescia, Italy
| | - N Villa
- Medical Oncology Department, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 20123, Brescia, Italy
| | - A Alberti
- Medical Oncology Department, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 20123, Brescia, Italy
| | - N Di Meo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - C Gonano
- Medical Oncology Department, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 20123, Brescia, Italy
| | - B Zanini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - M Laganà
- Medical Oncology Department, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 20123, Brescia, Italy
| | - G Ippolito
- Medical Oncology Department, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 20123, Brescia, Italy
| | - L Rinaudo
- Tecnologie Avanzate Srl, Turin, Italy
| | - D Farina
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - M Castellano
- Department of Internal Medicine and Endocrinology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - C Cappelli
- Department of Internal Medicine and Endocrinology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - E L Simoncini
- SSVD Breast Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - D Cosentini
- Medical Oncology Department, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 20123, Brescia, Italy
| | - A Berruti
- Medical Oncology Department, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 20123, Brescia, Italy
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