Chemotherapy and Bone Loss
Well, more concerning news and evidence that everything has risks as well as benefits. We have long known that hormonal treatments (most specifically, the AIs) result in loss of bone density for most women. This German study, here summarized in MedWireNews, suggests that some chemotherapies may have the same effect. Looking hard for a silver lining, I will remind you of recent evidence that bone strengthening drugs, both IV and oral, have a positive impact on reducing the risk of bone mets or the incidence among women who have Stage IV cancers. See the blog of a few days ago re "What's Hot at the San Antonio...." for more specifics.
Here is the article:
Breast cancer chemotherapy harms bone health
By Laura Dean
03 December 2009
Eu J Cancer 2009;
Researchers in Germany have confirmed the deleterious effect of doxorubicin and cyclophosphamide on bone health in premenopausal women with breast cancer, and show that quantitative ultrasonography (QUS) can be used to monitor these patients.
In a 1-year, prospective study, Peyman Hadji and colleagues from Philipps-University of Marburg evaluated the effects of six cycles of chemotherapy with doxorubicin and cyclophosphamide on bone mineral density (BMD), QUS and bone turnover in 53 premenopausal women with estrogen receptor-negative breast cancer. The results were compared with 53 healthy matched controls.
The researchers measured BMD by dual X-ray absorptiometry at the spine and hip, took QUS measurements at the calcaneus and phalanges, and measured bone turnover markers in serum at baseline and 6 and 12 months after chemotherapy. They found that women in the control group had stable BMD at all sites throughout the study period. In contrast, at 12 months the BMD at the femoral neck, total hip, and lumbar spine were a significant 2.8%, 4.0%, and 5.2% lower than at baseline, respectively.
Furthermore, the control group had stable ultrasound findings throughout the trial whereas patients with breast cancer had significant reductions in QUS speed of sound (SOS) at both the phalanges and calcaneus. The mean QUS SOS for the phalanges decreased by 2.2% at 12 months versus baseline, while the stiffness index for calcaneal bone was 4.3% lower at 12 months than at baseline.
Biochemical markers for bone turnover also remained stable in the control group but increased significantly in the women with breast cancer. The researchers observed 93% increase in N-terminal propeptide of type I procollagen, a 33% increase in C-telopeptide of type I collagen, and a 37% increase in bone-specific alkaline phosphatase during the study.
Of note, there were significant correlations between BMD, QUS, and bone markers.
"The dramatic loss of BMD and the associated long-term fracture risk underscore the need for preventive measures in this at-risk patient population," conclude Hadji and co-authors in the European Journal of Cancer.
They add: "Although DXA is the current gold standard for assessing BMD, we have now established the utility of QUS for assessing changes in bone metabolism in these patients."
MedWire (www.medwire-news.md) is an independent clinical news