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Ebstein E, Brocard P, Soussi G, Khoury R, Forien M, Khalil A, Vauchier C, Juge PA, Léger B, Ottaviani S, Dieudé P, Zalcman G, Gounant V. Burden of comorbidities: Osteoporotic vertebral fracture during non-small cell lung cancer - the BONE study. Eur J Cancer 2024; 200:113604. [PMID: 38340385 DOI: 10.1016/j.ejca.2024.113604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/29/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Immunotherapy and targeted therapy have extended life expectancy in non-small cell lung cancer (NSCLC) patients, shifting it into a chronic condition with comorbidities, including osteoporosis. This study aims to evaluate the prevalence and incidence of osteoporotic vertebral fracture (OPVF) during NSCLC follow-up, identify risk factors of OPVF, and determine the impact on overall survival (OS). METHODS We performed a longitudinal single-center retrospective cohort study involving patients with histologically proven NSCLC of any stage. Chest-abdomen-pelvis computed tomography (CAP CT) at diagnosis and during follow-up were double-blind reviewed to determine OPVF site, count, type, time to incident OPVF, and trabecular volumetric bone density (TVBD). An institutional expert committee adjudicated discrepancies. Binary logistic regression was used to predict the occurrence of incident OPVF. OS was calculated using the Kaplan-Meier method. RESULTS We included 289 patients with a median follow-up of 29.7 months. OPVF prevalence was 10.7% at inclusion and 23.2% at the end of follow-up. Cumulative incidence was 12.5%, with an incidence rate of 4 per 100 patient-years. Median time to incident OPVF was 13 months (IQR: 6.7-21.2). Seven of the 36 patients with incident OPVF received denosumab or bisphosphonates. In multivariable analysis, independent risk factors for incident OPVF were BMI < 19 kg/m2 (OR: 5.62, 95%CI 1.84-17.20, p = 0.002), lower TVBD (OR: 0.982 per HU, 95%CI 0.97-0.99, p = 0.001) and corticosteroid use (OR: 4.77, 95%CI: 1.76-12.89, p = 0.001). OPVF was not significantly associated with OS. CONCLUSIONS Osteoporosis should be screened for in NSCLC patients. Thoracic oncologists must broaden the use of steroid-induced osteoporosis recommendations.
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Affiliation(s)
- E Ebstein
- Université Paris Cité, Rheumatology Department, Hôpital Bichat Claude-Bernard, Paris, France
| | - P Brocard
- Université Paris Cité, Rheumatology Department, Hôpital Bichat Claude-Bernard, Paris, France
| | - G Soussi
- Pulmonology Department, Hôpital Forcilles - Fondation Cognacq-Jay, 77150 Férolles-Attily, France
| | - R Khoury
- Université Paris Cité, Radiology Department, Hôpital Bichat Claude-Bernard, Paris, France
| | - M Forien
- Université Paris Cité, Rheumatology Department, Hôpital Bichat Claude-Bernard, Paris, France
| | - A Khalil
- Université Paris Cité, Radiology Department, Hôpital Bichat Claude-Bernard, Paris, France
| | - C Vauchier
- Université Paris Cité, Thoracic Oncology Department, CIC INSERM 1425, Institut du Cancer AP-HP.Nord, Hôpital Bichat Claude-Bernard, Paris, France
| | - P A Juge
- Université Paris Cité, Rheumatology Department, Hôpital Bichat Claude-Bernard, Paris, France
| | - B Léger
- Université Paris Cité, Rheumatology Department, Hôpital Bichat Claude-Bernard, Paris, France
| | - S Ottaviani
- Université Paris Cité, Rheumatology Department, Hôpital Bichat Claude-Bernard, Paris, France
| | - P Dieudé
- Université Paris Cité, Rheumatology Department, Hôpital Bichat Claude-Bernard, Paris, France
| | - G Zalcman
- Université Paris Cité, Thoracic Oncology Department, CIC INSERM 1425, Institut du Cancer AP-HP.Nord, Hôpital Bichat Claude-Bernard, Paris, France
| | - V Gounant
- Université Paris Cité, Thoracic Oncology Department, CIC INSERM 1425, Institut du Cancer AP-HP.Nord, Hôpital Bichat Claude-Bernard, Paris, France.
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Ait Oumghar I, Barkaoui A, Merzouki T, Guenoun D, Chabrand P. Chemotherapy and adjuvant therapies' impact on the internal remodeling process of bone and its mechanical behavior for breast cancer patients. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024; 40:e3788. [PMID: 37960964 DOI: 10.1002/cnm.3788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/17/2023] [Accepted: 10/01/2023] [Indexed: 11/15/2023]
Abstract
Breast cancer is a significant public health issue affecting women worldwide. While advancements in treatment options have led to improved survival rates, the impact of breast cancer and its treatments on bone health cannot be overlooked. Bone remodeling is a complex process regulated by the delicate balance between bone formation and resorption. Any disruption to this balance can lead to decreased bone density, increased fracture risk, and compromised physical function. To investigate the effects of breast cancer and its treatments on bone remodeling, a finite element model was developed in this study. This model incorporated bone remodeling equations to simulate the mechanical behavior of bone under different conditions. The ABAQUS/UMAT software was used to simulate the behavior of bone tissue under the influence of breast cancer and treatments. Our findings suggest that bone loss is more pronounced after secondary breast cancer and treatment, leading to bone loss (6%-19% decrease in BV/TV), reduced bone stimulation, and decreased effectiveness of physical activity on recovery. These results highlight the importance of early intervention and management of bone health in breast cancer patients to mitigate the negative impact of cancer and treatment on bone remodeling.
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Affiliation(s)
- Imane Ait Oumghar
- Laboratoire des Energies Renouvelables et Matériaux Avancés (LERMA), Université Internationale de Rabat, Rabat, Morocco
- Institut des Sciences du Mouvement (ISM), Université Aix-Marseille, Marseille, France
| | - Abdelwahed Barkaoui
- Laboratoire des Energies Renouvelables et Matériaux Avancés (LERMA), Université Internationale de Rabat, Rabat, Morocco
| | - Tarek Merzouki
- Laboratoire d' Ingénierie des Systèmes de Versailles LISV, IUT de Mantes en Yvelines Université de Versailles Saint-Quentin, Mantes-La-Jolie, France
| | - Daphne Guenoun
- Institut des Sciences du Mouvement (ISM), Université Aix-Marseille, Marseille, France
| | - Patrick Chabrand
- Institut des Sciences du Mouvement (ISM), Université Aix-Marseille, Marseille, France
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Amigues C, Fresse A, Roux CH, Gauthier S, Vieillard MH, Drici MD, Breuil V. Zoledronate and osteonecrosis of the jaw in osteoporosis: incidence and risk factors. Analysis of the French Pharmacovigilance Database. Joint Bone Spine 2023; 90:105599. [PMID: 37271278 DOI: 10.1016/j.jbspin.2023.105599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Bisphosphonate-related osteonecrosis of the jaw (BRONJ) have been characterized with the use of oral bisphosphonates in osteoporosis and zoledronate in oncology. Uncertainties remain, though, with the occurrence of BRONJ related to the use of zoledronate in osteoporosis. OBJECTIVES We aimed to estimate the incidence and characterize the risk factors of zoledronate-associated BRONJ in osteoporosis as compared with oral bisphosphonates in real life setting. METHODS Cases of BRONJ associated with zoledronate, alendronate or risedronate were extracted from the French pharmacovigilance database up to 2020. The incidence of BRONJ was estimated as their respective numbers related to cases of BRONJ in patients treated with bisphosphonates for osteoporosis, over the same period, according to the Medic'AM database. RESULTS Between 2011 and 2020, BRONJ incidence with zoledronate was 9.6/100,000 patient-year (PY), significantly higher than with alendronate (5.1/100,000 PY, P<0.001), and risedronate (2.0/100,000 PY, P<0.001). The number of patients treated with bisphosphonates has steadily decreased by 44.5% over 10 years. Meanwhile, the incidence of BRONJ decreased (5.8/100,000 PY in 2011; 1.5/100,000 in 2020), although a rebound was observed in 2018, including 47.6% of BRONJ following denosumab. Apart from classical risk factors, recent dental cares stood out in more than 40% of BRONJ, and zoledronate had a shorter exposure time than oral bisphosphonates. CONCLUSIONS In a real-life setting, our data confirm that zoledronate-associated BRONJ in osteoporosis is scarce, seeming slightly more common compared with oral bisphosphonates. We also raise awareness of dental care guidelines and greater vigilance when using bisphosphonates in patients with previous exposure to denosumab.
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Affiliation(s)
- Claire Amigues
- Université Côte d'Azur (UCA), service de rhumatologie, CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, CS 51069, 06001 Nice cedex 1, France
| | - Audrey Fresse
- Université Côte d'Azur Medical Center, Department of Pharmacology, Nice, France
| | - Christian Hubert Roux
- Université Côte d'Azur (UCA), service de rhumatologie, CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, CS 51069, 06001 Nice cedex 1, France
| | - Sophie Gauthier
- CHU de Lille, Pharmacology Department, centre régional de pharmacovigilance, university Lille, 59000 Lille, France
| | - Marie-Hélène Vieillard
- CHU de Lille, Department of Rheumatology, University Lille, 59000 Lille, France; Oscar Lambret Cancer Center, Lille, France; CANTHER, Team Target UMR 9020 CNRS, UMR-S 1277 Inserm, université de Lille, institut Pasteur de Lille, Lille, France
| | - Milou-Daniel Drici
- Université Côte d'Azur Medical Center, Department of Pharmacology, Nice, France
| | - Véronique Breuil
- Université Côte d'Azur (UCA), service de rhumatologie, CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, CS 51069, 06001 Nice cedex 1, France; Université Côte d'Azur (UCA), UMR E-4320 MATOs CEA/iBEB/SBTN, faculté de médecine, 28, avenue de Valombrose, 06107 Nice cedex 2, France.
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Wang SF, Lin YS, Yeh WY, Chang YL, Chiang CE, Chen CH, Tseng LM, Lee HC, Liu CY, Cheng HM. The Clinical Benefits of Antiresorptive Agents in Patients with Primary Breast Cancer Receiving Adjuvant Endocrine Therapy: A Systematic Review with Pairwise and Network Meta-analysis. J Clin Endocrinol Metab 2023; 108:e1433-e1447. [PMID: 37170778 DOI: 10.1210/clinem/dgad247] [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: 10/18/2022] [Revised: 03/28/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023]
Abstract
CONTEXT Clinical trials have investigated the role of antiresorptive agents, including bisphosphonates and denosumab, in patients with primary breast cancer receiving adjuvant endocrine therapy, aiming for better bone protection and/or improving survival. OBJECTIVE To summarize the clinical effects of antiresorptive agents in patients with early breast cancer receiving endocrine therapy. METHODS We systematically reviewed and synthesized the clinical benefits and harms of antiresorptive agents in patients with early breast cancer receiving endocrine therapy by calculating the risk ratios (RRs). RESULTS In the pooled meta-analysis, antiresorptive agents had significant clinical benefits on disease recurrence (RR 0.78, 95% CI 0.67-0.90) and locoregional recurrence (RR 0.69, 95% CI 0.49-0.95) in patients with breast cancer receiving endocrine therapy. Early use of antiresorptive agents has a beneficial effect on secondary endocrine therapy resistance instead of primary resistance. Safety analysis revealed that potential risk for osteonecrosis of the jaw (ONJ, RR 3.29, 95% CI 1.12-9.68) with antiresorptive agents; however, there is an insignificant difference in arthralgia. The subgroup analyses revealed that intervention with bisphosphonates might have profound clinical benefits, but also increased the occurrence of ONJ. A network meta-analysis further supported the clinical effects of early antiresorptive agent use compared with delayed use or placebo. CONCLUSION Using antiresorptive agents early in patients with breast cancer receiving adjuvant endocrine therapy may provide additional benefits in risk reduction of recurrence, but there is a potential risk of ONJ.
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Affiliation(s)
- Sheng-Fan Wang
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei 112, Taiwan, R.O.C
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei 112, Taiwan, R.O.C
- Department and Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, R.O.C
| | - Yi-Sheng Lin
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei 112, Taiwan, R.O.C
- Department and Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, R.O.C
| | - Wan-Yu Yeh
- Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan, R.O.C
- Department of Medical Education, Taipei Veterans General Hospital, Taipei 112, Taiwan, R.O.C
| | - Yuh-Lih Chang
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei 112, Taiwan, R.O.C
- Department and Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, R.O.C
- Faculty of Pharmacy, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, R.O.C
| | - Chern-En Chiang
- School of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 112, Taiwan, R.O.C
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei 112, Taiwan, R.O.C
| | - Chen-Huan Chen
- Department of Medical Education, Taipei Veterans General Hospital, Taipei 112, Taiwan, R.O.C
- School of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 112, Taiwan, R.O.C
- Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University School of Medicine, Taipei 112, Taiwan, R.O.C
| | - Ling-Ming Tseng
- Department of Surgery, Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei 112, Taiwan, R.O.C
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, R.O.C
| | - Hsin-Chen Lee
- Department and Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, R.O.C
- Faculty of Pharmacy, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, R.O.C
| | - Chun-Yu Liu
- School of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 112, Taiwan, R.O.C
- Department of Surgery, Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei 112, Taiwan, R.O.C
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei 112, Taiwan, R.O.C
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan, R.O.C
| | - Hao-Min Cheng
- Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan, R.O.C
- Department of Medical Education, Taipei Veterans General Hospital, Taipei 112, Taiwan, R.O.C
- School of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 112, Taiwan, R.O.C
- Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University School of Medicine, Taipei 112, Taiwan, R.O.C
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Bertrand N, Bridoux M, Gaxatte C, Abi Rached H, Turpin A, Letarouilly JG, Vieillard MH. Preserving bone in cancers of the elderly: A necessity. Joint Bone Spine 2023; 90:105549. [PMID: 36796583 DOI: 10.1016/j.jbspin.2023.105549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 01/19/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
The occurrence of bone fractures is frequent in the elderly population, and in cancer patients, especially with bone metastases. The growing incidence of cancer associated with an aging population implies important health challenges, including bone health. Decisions on cancer care in older adults have to take into account older adults' specificities. Screening tools as G8 or VES 13 and evaluating tools as comprehensive geriatric assessment (CGA) do not include bone-related items. Bone risk assessment is indicated according to identification of geriatric syndromes such as falls, history, and the oncology treatment plan. Some cancer treatments disrupt bone turnover and decrease bone mineral density. This is mainly caused by hypogonadism, induced by hormonal treatments and some chemotherapies. Treatments can also cause direct (i.e., chemotherapy, radiotherapy or glucocorticoids) or indirect toxicity through electrolyte disorders (i.e., some chemotherapies or tyrosine kinase inhibitors) on bone turnover. Bone risk prevention is multidisciplinary. Certain interventions proposed in the CGA aim to improve bone health and reduce the risk of falling. It is also based on the drug management of osteoporosis, and the prevention of complications from bone metastases. Management of fractures, related or not to bone metastases relates to the concept of orthogeriatrics. It is also based on the benefit-risk ratio of the operation, access to minimally invasive techniques, prehabilitation or rehabilitation, but also the prognosis related to cancer and geriatric syndromes. Bone health is essential in older cancer patient's care. Bone risk assessment should be part of CGA in routine use and specific decision-making tools should be developed. Bone event management must be integrated throughout the patient's care pathway and oncogeriatrics multidisciplinarity should include rheumatological expertise.
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Affiliation(s)
- Nicolas Bertrand
- Université Lille, CHU de Lille, ULR 2694 METRICS, 59000 Lille, France.
| | - Marie Bridoux
- Université Lille, CHU Lille, Medical Oncology Department, 59000 Lille, France
| | | | | | - Anthony Turpin
- University Lille, CNRS, Inserm, CHU Lille, UMR9020-UMR-S 1277, CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, 59000 Lille, France
| | - Jean-Guillaume Letarouilly
- Université Lille, CHU de Lille, ULR 4490 MABLab, FHU PRECISE, service de rhumatologie, 59000 Lille, France
| | - Marie-Hélène Vieillard
- CHU de Lille, Department of Rheumatologie & Oscar Lambret Center, Supportive care department, Université Lille, CNRS, Inserm, UMR9020-UMR-S 1277, CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, 59000 Lille, France
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Ait Oumghar I, Barkaoui A, Ghazi AE, Chabrand P. Modeling and simulation of bone cells dynamic behavior under the late effect of breast cancer treatments. Med Eng Phys 2023; 115:103982. [PMID: 37120177 DOI: 10.1016/j.medengphy.2023.103982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 04/14/2023] [Accepted: 04/19/2023] [Indexed: 05/01/2023]
Abstract
Breast Cancer (BC) treatments have been proven to interfere with the health of bones. Chemotherapy and endocrinal treatment regimens such as tamoxifen and aromatase inhibitors are frequently prescribed for women with BC. However, these drugs increase bone resorption and reduce the Bone Mineral Density (BMD), thus increasing the risk of bone fracture. In the current study, a mechanobiological bone remodeling model has been developed by coupling cellular activities, mechanical stimuli, and the effect of breast cancer treatments (chemotherapy, tamoxifen, and aromatase inhibitors). This model algorithm has been programmed and implemented on MATLAB software to simulate different treatment scenarios and their effects on bone remodeling and also predict the evolution of Bone Volume fraction (BV/TV) and the associated Bone Density Loss (BDL) over a period of time. The simulation results, achieved from different combinations of Breast Cancer treatments, allow the researchers to predict the intensity of each combination treatment on BV/TV and BMD. The combination of chemotherapy, tamoxifen, and aromatase inhibitors, followed by the combination of chemotherapy and tamoxifen remain the most harmful regimen. This is because they have a strong ability to induce the bone degradation which is represented by a decrease of 13.55% and 11.55% of the BV/TV value, respectively. These results were compared with the experimental studies and clinical observations which showed good agreement. The proposed model can be used by clinicians and physicians to choose the most appropriate combination of treatments, according to the patient's case.
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Affiliation(s)
- Imane Ait Oumghar
- Université Internationale de Rabat, LERMA Lab, Rocade Rabat Salé 11100, Rabat-Sala El Jadida, Morocco; Université Aix-Marseille, ISM, 163 av. de Luminy F-13288, Marseille cedex 09, France
| | - Abdelwahed Barkaoui
- Université Internationale de Rabat, LERMA Lab, Rocade Rabat Salé 11100, Rabat-Sala El Jadida, Morocco.
| | - Abdellatif El Ghazi
- Université Internationale de Rabat, TIC Lab, Rocade Rabat Salé 11100, Rabat-Sala El Jadida, Morocco
| | - Patrick Chabrand
- Université Aix-Marseille, ISM, 163 av. de Luminy F-13288, Marseille cedex 09, France
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Abstract
Individuals with cancer face unique risk factors for osteoporosis and fractures. Clinicians must consider the additive effects of cancer-specific factors, including treatment-induced bone loss, and premorbid fracture risk, utilizing FRAX score and bone mineral densitometry when available. Pharmacologic therapy should be offered as per cancer-specific guidelines, when available, or local general osteoporosis guidelines informed by clinical judgment and patient preferences. Our objective was to review and summarize the epidemiologic burden of osteoporotic fracture risk and fracture risk assessment in adults with cancer, and recommended treatment thresholds for cancer treatment-induced bone loss, with specific focus on breast, prostate, thyroid, gynecological, multiple myeloma, and hematopoietic stem cell transplant. This narrative review was informed by PubMed searches to July 25, 2022, that combined terms for cancer, stem cell transplantation, fracture, bone mineral density (BMD), trabecular bone score, FRAX, Garvan nomogram or fracture risk calculator, QFracture, prediction, and risk factors. The literature informs that cancer can impact bone health in numerous ways, leading to both systemic and localized decreases in BMD. Many cancer treatments can have detrimental effects on bone health. In particular, hormone deprivation therapies for hormone-responsive cancers such as breast cancer and prostate cancer, and hematopoietic stem cell transplant for hematologic malignancies, adversely affect bone turnover, resulting in osteoporosis and fractures. Surgical treatments such as hysterectomy with bilateral salpingo-oophorectomy for gynecological cancers can also lead to deleterious effects on bone health. Radiation therapy is well documented to cause localized bone loss and fractures. Few studies have validated the use of fracture risk prediction tools in the cancer population. Guidelines on cancer-specific treatment thresholds are limited, and major knowledge gaps still exist in fracture risk and fracture risk assessment in patients with cancer. Despite the limitations of current knowledge on fracture risk assessment and treatment thresholds in patients with cancer, clinicians must consider the additive effects of bone damaging factors to which these patients are exposed and their premorbid fracture risk profile. Pharmacologic treatment should be offered as per cancer-specific guidelines when available, or per local general osteoporosis guidelines, in accordance with clinical judgment and patient preferences.
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Affiliation(s)
- Carrie Ye
- University of Alberta, Edmonton, Canada.
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Mugnier B, Goncalves A, Daumas A, Couderc AL, Mezni E, Viret F, de Nonneville A, Villani P. Prevention of aromatase inhibitor-induced bone loss with anti-resorptive therapy in post-menopausal women with early-stage breast cancer. Osteoporos Int 2023; 34:703-711. [PMID: 36715715 DOI: 10.1007/s00198-023-06683-0] [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: 08/02/2022] [Accepted: 01/21/2023] [Indexed: 01/31/2023]
Abstract
UNLABELLED We assessed if antiresorptive treatment can prevent aromatase inhibitor-induced bone loss in patients with early breast cancer. We observed that patients who did not receive antiresorptive treatment had a 20.8-fold increase in risk of bone loss after 24 months of aromatase inhibitors therapy. PURPOSE This study aimed to describe changes in femoral and lumbar bone mineral density (BMD) after 24 months of aromatase inhibitors (AIs) and antiresorptive treatment in postmenopausal women with estrogen receptor-positive breast cancer. METHODS Prospective, longitudinal study in a real-life setting with a 2-year follow-up. Patients underwent a complete baseline bone assessment including clinical assessment, biological evaluation, BMD measurement, and spine X-ray. Antiresorptive treatment was prescribed to patients with a T-score < - 2 or a T-score < - 1.5 SD with additional osteoporosis risk factors. A follow-up bone assessment was carried out after 24 months. RESULTS Among 328 patients referred to our center, 168 patients (67.7 ± 10.6 years) were included in our study, and 144 were eligible for antiresorptive treatment. After 24 months, patients receiving antiresorptive treatment experienced a significant increase of + 6.28% in femoral-BMD (F-BMD) and + 7.79% in lumbar-BMD (L-BMD). This increase was not significantly different between osteoporotic and osteopenic patients. Conversely, patients not receiving antiresorptive treatment presented significant F-BMD and L-BMD loss regardless of the baseline BMD. In the multivariate logistic model, the lack of antiresorptive treatment was the only predictive factor for major femoral bone loss with a 20.83 odds ratio (CI95%:4.2-100, p < 0.001). CONCLUSION This real-life study confirmed that antiresorptive treatment significantly increases femoral and lumbar BMD regardless of the baseline BMD in postmenopausal patients receiving AIs for early breast cancer. Patients who did not receive antiresorptive treatment had a 20.8-fold increased risk of major bone loss. Nevertheless, the best threshold to adopt for starting antiresorptive agents remains undetermined.
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Affiliation(s)
- Bénédicte Mugnier
- APHM, Hôpital Sainte Marguerite, Service de Médecine Interne Gériatrie Et Thérapeutique, Marseille, France.
| | - Anthony Goncalves
- Département d'Oncologie Médicale, Centre de Recherche en Cancérologie de Marseille INSERM, Institut Paoli-Calmettes, CNRS, Université d'Aix-Marseille, Marseille, France
| | - Aurélie Daumas
- APHM, Hôpital La Timone, Service de Médecine Interne Gériatrie Et Thérapeutique, Marseille, France
| | - Anne-Laure Couderc
- APHM, Hôpital Sainte Marguerite, Service de Médecine Interne Gériatrie Et Thérapeutique, Marseille, France
| | - Essia Mezni
- Département d'Oncologie Médicale, Centre de Recherche en Cancérologie de Marseille INSERM, Institut Paoli-Calmettes, CNRS, Université d'Aix-Marseille, Marseille, France
| | - Frédéric Viret
- Département d'Oncologie Médicale, Centre de Recherche en Cancérologie de Marseille INSERM, Institut Paoli-Calmettes, CNRS, Université d'Aix-Marseille, Marseille, France
| | - Alexandre de Nonneville
- Département d'Oncologie Médicale, Centre de Recherche en Cancérologie de Marseille INSERM, Institut Paoli-Calmettes, CNRS, Université d'Aix-Marseille, Marseille, France
| | - Patrick Villani
- APHM, Hôpital Sainte Marguerite, Service de Médecine Interne Gériatrie Et Thérapeutique, Marseille, France
- APHM, Hôpital La Timone, Service de Médecine Interne Gériatrie Et Thérapeutique, Marseille, France
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Bassatne A, Bou Khalil A, Chakhtoura M, Arabi A, Van Poznak C, El-Hajj Fuleihan G. Effect of antiresorptive therapy on aromatase inhibitor induced bone loss in postmenopausal women with early-stage breast cancer: A systematic review and meta-analysis of randomized controlled trials. Metabolism 2022; 128:154962. [PMID: 34958816 DOI: 10.1016/j.metabol.2021.154962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/30/2021] [Accepted: 12/14/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Aromatase inhibitors (AIs) are routinely used to treat postmenopausal women with early-stage breast cancer. Although AIs improve breast cancer outcomes, they increase the risk of osteoporosis and fractures. This systematic review and meta-analysis assesses the effect of antiresorptive drugs on AI induced bone loss in postmenopausal women with non-metastatic breast cancer. METHODS We searched four databases until November 4th 2020. We included Randomized controlled trials (RCTs) of antiresorptive drugs in postmenopausal women with breast cancer treated with AI. Two authors screened studies, extracted data and assessed the risk of bias independently and in duplicate. RESULTS We identified 14 RCTs: 7 on zoledronic acid, 6 on oral bisphosphonates and 1 on denosumab. The mean difference in bone mineral density (BMD) was 5% at the lumbar spine and 4% at the total hip, at 12 months, favoring zoledronic acid compared to control. The certainty of the evidence was low for lumbar spine and moderate for total hip BMD. Similarly, the mean difference was 3% at the lumbar spine and 2% at the total hip, favoring oral bisphosphonates with moderate certainty. The mean difference was 6% at the lumbar spine, and 4% at the total hip BMD favoring denosumab compared to placebo. In addition, zoledronic acid resulted in a mean difference in bone turnover marker levels of -35-41%, and the relarive risk for morphometric vertebral fractures was 0.7 [0.3-1.4], compared to control. Denosumab reduced fracture incidence by 50% compared to placebo. CONCLUSION Evidence suggests a protective effect of antiresorptive drugs on BMD and bone turnover markers in postmenopausal women with non-metastatic breast cancer on AI. However, data on fracture risk reduction remains unclear.
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Affiliation(s)
- Aya Bassatne
- Calcium Metabolism and Osteoporosis Program, Division of Endocrinology and Metabolism, WHO Collaborating Center in Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abir Bou Khalil
- Calcium Metabolism and Osteoporosis Program, Division of Endocrinology and Metabolism, WHO Collaborating Center in Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marlene Chakhtoura
- Calcium Metabolism and Osteoporosis Program, Division of Endocrinology and Metabolism, WHO Collaborating Center in Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Asma Arabi
- Calcium Metabolism and Osteoporosis Program, Division of Endocrinology and Metabolism, WHO Collaborating Center in Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, Division of Endocrinology and Metabolism, WHO Collaborating Center in Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Lespessailles É. Ostéodensitométrie : intérêts dans la prise en charge de la fragilité osseuse. IMAGERIE DE LA FEMME 2020. [DOI: 10.1016/j.femme.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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11
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Bortolozo HI, Derchain S, Vechin FC, Maginador GF, Santos IS, Torresan R, de Nazaré Silva Dos Santos P, Sarian LO, Conceição MS. Aerobic Fitness is a Predictor of Body Composition in Women With Breast Cancer at Diagnosis. Clin Breast Cancer 2020; 21:e245-e251. [PMID: 34159902 DOI: 10.1016/j.clbc.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/17/2020] [Accepted: 10/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The objective of this study was to investigate the relationship of aerobic fitness (AF) at diagnosis, before treatment and its relationship with body composition, physical function, lipidic profile, comorbidities, tumor characteristics, and quality of life of women with breast cancer (BC) PATIENTS AND METHODS: This cross-sectional cohort study included 78 women with BC that were assessed before treatment. A 6-minute walk test was used to evaluate the subjects' AF, estimating the maximum oxygen consumption (VO2max) to classify the women with BC into 2 groups: good/excellent AF or fair/weak/very weak AF. Dual-energy x-ray absorptiometry was performed to assess body composition. The International Global Physical Activity Questionnaire and the Functional Assessment of Cancer Therapy - Fatigue questionnaires were applied to assess the level of physical activity and the quality of life, respectively. RESULTS Among the women included, the majority (81%) had the luminal subtype of BC. Most of the women were diagnosed with T1/T2 tumors and with negative axillary lymph nodes. We found that women with BC with good/excellent AF (VO2max = 32.9 ± 6.0 mL/kg/min-1) presented significantly lower weight, body mass index, abdominal circumference, percentual and total body fat, and bone mineral density compared with women with fair/weak/very weak AF (VO2max = 21.8 ± 6.9 mL/kg/min-1). Also, women with BC with good/excellent AF showed better performance on physical functional tests. No relationship between estimated VO2max and comorbidities, tumor characteristics, or quality of life was found. CONCLUSION AF is a predictor of body composition and physical function in women with BC. These data suggest that women with BC with higher AF can decrease the chance of adverse effects during BC treatment.
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Affiliation(s)
- Henrique Ims Bortolozo
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Sophie Derchain
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Felipe C Vechin
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Guilherme F Maginador
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Izabella Silva Santos
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Renato Torresan
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | | | - Luís Otávio Sarian
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Miguel S Conceição
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil; School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil; Faculty of Physical Education, University of Campinas, Campinas, São Paulo, Brazil.
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