New guidance for management of aromatase-inhibitor related bone loss in breast cancer

April 25, 2017, International Osteoporosis Foundation

A new Position Statement, jointly published by seven international and European organizations, identifies fracture-related risk factors in patients treated by aromatase-inhibitors (AI) and outlines key management strategies to help prevent bone loss and related fractures.

The Statement is authored by experts from the International Osteoporosis Foundation (IOF), Cancer and Bone Society (CABS), International Expert Group for AIBL (IEG), European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), European Calcified Tissue Society (ECTS), International Menopause Society (IMS), and the International Society for Geriatric Oncology (SIOG).

Download 'Joint Position Statement: Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive '

Women receiving adjuvant AI therapy for breast cancer experience a two to four-fold increase in compared to the normal rate of bone loss with menopause—and as a result they are at heightened risk of fracture.

Professor René Rizzoli, Chairman of the IOF Bone and Cancer Working Group, stated: "While clinical trials have shown an approximately 10% increase in absolute fracture risk for women on AI therapy, other real-world studies indicate that the fracture risk may be significantly higher. Additionally, breast cancer hospitalized for a bone fracture showed a higher risk of death compared to breast cancer patients without a . These are compelling reasons to ensure that all women on AI therapy for breast cancer receive early assessment and treatment."

Among its conclusions, the Position states:

  • In all patients initiating AI treatment, fracture risk should be assessed and recommendations given in regard to exercise and calcium/vitamin D supplementation
  • Bone-directed therapy should be recommended for the duration of AI treatment to all patients with a T-score <-2.0 SD, or with a T-score of <-1.5 SD with one additional risk factor, or with two or more risk factors (without BMD)
  • Patients with a T-score > - 1.5 SD and no risk factors should be managed based on BMD loss during the first year, and based on local guidelines for postmenopausal osteoporosis
  • Based on current evidence, six monthly denosumab or yearly zoledronate for the duration of AI therapy is recommend for the prevention of AIBL in postmenopausal women receiving adjuvant AI therapy, with zoledronate recommended when effects on disease recurrence are the priority, and denosumab when fracture risk is the dominant concern.
  • Because of the decreased incidence of bone recurrence and breast cancer specific mortality associated with bisphosphonate use, adjuvant bisphosphonates are recommended for all postmenopausal women at significant risk of disease recurrence.
  • Compliance should be regularly assessed as well as BMD after 12-24 months on treatment.

Professor Peyman Hadji, first author of the paper and board member of the Cancer and Bone Society, added: "As fragility fractures often result in prolonged disability and loss of independence, it is important that women who are being treated for hormone-sensitive breast cancer are managed to prevent bone loss and related fractures. As well, given that recent research has revealed the potential anticancer benefits of antiresorptive agents in early breast cancer, these agents can also play a role in preventing disease recurrence."

The authors note that in addition to the established risk factors used in the Position Statement's health algorithm, other potential factors in women with breast include chemotherapy, radiotherapy, low weight, and family history of hip . Further studies examining the role of these factors are encouraged and annual assessment of with these potential factors may be prudent.

Explore further: New study confirms link between early menopause and higher risk of fracture

More information: Peyman Hadji et al, Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO, IMS, and SIOG, Journal of Bone Oncology (2017). DOI: 10.1016/j.jbo.2017.03.001

Related Stories

New study confirms link between early menopause and higher risk of fracture

November 2, 2016
If you're in menopause before the age of 40, you have a higher fracture risk. That fact has already been proven by the Women's Health Initiative (WHI) clinical trials. Now a new study evaluating the same WHI data further ...

Men face greater risk of death following osteoporosis-related fractures

March 14, 2017
Men face a greater risk of mortality following a fracture related to osteoporosis, a common disease where the bones become weak and brittle, according to new research presented today at the 2017 Annual Meeting of the American ...

Less than half of elderly hip fracture patients take vitamin D supplements

March 14, 2017
Despite national recommendations for daily vitamin D intake, a new study presented today at the 2017 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) found that just 45.7 percent of patients reported ...

New IOF review provides guidance on fracture prevention in cancer-associated bone disease

November 1, 2013
Cancer is a health burden of increasing importance which affects close to 13 million people globally. Bone is often affected in these patients, frequently because of bone metastases, or as a result of anti-cancer therapies ...

Osteoporosis screening and treatment fall short for women with hip fractures

February 23, 2017
It's important to identify and treat osteoporosis following hip fracture, but a large study found low rates of assessment and treatment in postmenopausal women who had suffered a hip fracture.

Menopausal hormone therapy improves bone health

November 17, 2016
Women who undergo hormone therapy for menopausal symptoms such as hot flashes can not only increase bone mass, but also can improve bone structure, according to a new study published in the Endocrine Society's Journal of ...

Recommended for you

Scientists take step toward new, targeted lung cancer treatment

August 21, 2018
Scientists have identified a key molecular player in a subtype of lung cancer which could lead to a new way to tackle the disease, according to research published in Nature Communications.

Simple test could identify bladder cancer patients who won't respond to immunotherapy

August 21, 2018
Patients who are unlikely to benefit from a commonly used immunotherapy for bladder cancer could be identified by a simple blood test, according to researchers at Brighton and Sussex Medical School (BSMS).

New compound advances into Phase 1 trial for pancreatic cancer

August 21, 2018
A compound discovered at Sanford Burnham Prebys Medical Discovery Institute (SBP) has advanced into a Phase 1 trial for metastatic pancreatic cancer. Called CEND-1 (scientifically known as iRGD), the compound was exclusively ...

Annual pap test a 'thing of the past?'

August 21, 2018
The United States Preventive Services Task Force (USPSTF) has released new recommendations on screening for cervical cancer. These latest recommendations continue the trend of decreasing participant burden by lengthening ...

'Liquid biopsy' predicts lymphoma therapy success within days, study finds

August 20, 2018
A blood test can predict which patients with a type of cancer called diffuse large B cell lymphoma are likely to respond positively to initial therapy and which are likely to need more aggressive treatment, according to a ...

Study shows how to make (and destroy) a metastatic cancer cell

August 20, 2018
Many cancers become especially dangerous only when they metastasize from their site of origin to faraway tissues such as lung, brain or bone. Now, a University of Colorado Cancer Center study published today in the Proceedings ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.