TY - JOUR
T1 - Cancer treatment-induced bone loss in premenopausal women
T2 - A need for therapeutic intervention?
AU - Hadji, P.
AU - Gnant, M.
AU - Body, J. J.
AU - Bundred, N. J.
AU - Brufsky, A.
AU - Coleman, R. E.
AU - Guise, T. A.
AU - Lipton, A.
AU - Aapro, M. S.
N1 - Funding Information:
Dr. Hadji has received honoraria and unrestricted educational grants from Amgen, AstraZeneca, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer, Roche, Sanofi-Aventis, and Wyeth. Dr. Aapro has conducted studies and is a consultant on bisphosphonates for Amgen, Bayer-Schering, Novartis, and Roche. Dr. Body has received consultancy and speaker fees from Novartis and Amgen. Dr. Bundred has received lecture fees from Novartis, Pfizer, and Roche, and research funding from Novartis, Pfizer, and Merck. Dr. Brufsky has served as a consultant and has conducted clinical trials for Novartis. Dr. Coleman has received consultancy fees from Novartis, Amgen, and Pfizer; speaker fees from Novartis, Roche, Pfizer, AstraZeneca, and Amgen; and research funding from Novartis and has given expert testimony on their behalf. Dr. Gnant reports receiving research support from and serving as a consultant for AstraZeneca, Novartis, and Pfizer, and receiving lecture fees and honoraria for participation on advisory boards from AstraZeneca, Novartis, Sanofi-Aventis, Roche, Schering, Amgen, and Pfizer. Dr. Guise has participated in speakers’ bureaus and been an advisor for Amgen, Novartis, Lilly, Roche, and AstraZeneca; and owns stock in Amgen. Dr. Lipton has participated in speakers’ bureaus for Amgen, Novartis, and Genentech; advisory boards for Amgen, Novartis, Cephalon, and Thar Pharmaceuticals; has received research support from Novartis, Monogram Biosciences, Oncogene Science, and PA Breast Cancer Coalition; and has provided expert testimony for Novartis.
PY - 2012/10
Y1 - 2012/10
N2 - Current clinical treatment guidelines recommend cytotoxic chemotherapy, endocrine therapy, or both (with targeted therapy if indicated) for premenopausal women with early-stage breast cancer, depending on the biologic characteristics of the primary tumor. Some of these therapies can induce premature menopause or are specifically designed to suppress ovarian function and reduce circulating estrogen levels. In addition to bone loss associated with low estrogen levels, cytotoxic chemotherapy may have a direct negative effect on bone metabolism. As a result, cancer treatment-induced bone loss poses a significant threat to bone health in premenopausal women with breast cancer. Clinical trials of antiresorptive therapies, such as bisphosphonates, have demonstrated the ability to slow or prevent bone loss in this setting. Current fracture risk assessment tools are based on data from healthy postmenopausal women and do not adequately address the risks associated with breast cancer therapy, especially in younger premenopausal women. We therefore recommend that all premenopausal women with breast cancer be informed about the potential risk of bone loss prior to beginning anticancer therapy. Women who experience amenorrhea should have bone mineral density assessed by dual-energy X-ray absorptiometry and receive regular follow-up to monitor bone health. Regular exercise and daily calcium and vitamin D supplementation are recommended. Women with a Z-score <-2.0 or Z-score ≤-1.0 and/or a 5-10% annual decrease in bone mineral density should be considered for bisphosphonate therapy in addition to calcium and vitamin D supplements.
AB - Current clinical treatment guidelines recommend cytotoxic chemotherapy, endocrine therapy, or both (with targeted therapy if indicated) for premenopausal women with early-stage breast cancer, depending on the biologic characteristics of the primary tumor. Some of these therapies can induce premature menopause or are specifically designed to suppress ovarian function and reduce circulating estrogen levels. In addition to bone loss associated with low estrogen levels, cytotoxic chemotherapy may have a direct negative effect on bone metabolism. As a result, cancer treatment-induced bone loss poses a significant threat to bone health in premenopausal women with breast cancer. Clinical trials of antiresorptive therapies, such as bisphosphonates, have demonstrated the ability to slow or prevent bone loss in this setting. Current fracture risk assessment tools are based on data from healthy postmenopausal women and do not adequately address the risks associated with breast cancer therapy, especially in younger premenopausal women. We therefore recommend that all premenopausal women with breast cancer be informed about the potential risk of bone loss prior to beginning anticancer therapy. Women who experience amenorrhea should have bone mineral density assessed by dual-energy X-ray absorptiometry and receive regular follow-up to monitor bone health. Regular exercise and daily calcium and vitamin D supplementation are recommended. Women with a Z-score <-2.0 or Z-score ≤-1.0 and/or a 5-10% annual decrease in bone mineral density should be considered for bisphosphonate therapy in addition to calcium and vitamin D supplements.
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U2 - 10.1016/j.ctrv.2012.02.008
DO - 10.1016/j.ctrv.2012.02.008
M3 - Review article
C2 - 22429722
AN - SCOPUS:84861691129
SN - 0305-7372
VL - 38
SP - 798
EP - 806
JO - Cancer Treatment Reviews
JF - Cancer Treatment Reviews
IS - 6
ER -