Treating Bone Loss

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Treating Bone Loss

Posted 1/2/2011

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A well-known and unfortunate side effect of most systemic treatments for breast cancer is possible bone density loss. This can happen with chemotherapy when a younger woman is thrust suddenly into menopause. This is what happened to me in 1993, probably more than a decade before it would have happened naturally. For all of us (and there are many) in this situation, it means that we have to be alert to the changes related to menopause for many more years than otherwise would have mattered. Women with hormone positive (ER positive) tumors who are treated with one of the AIs know that weakened bone density is a common side effect. Most doctors suggest that their patients have yearly bone density scans and have a low threshold for starting treatment.

Here is an article from the Annals of Oncology about treatments for bone strength. I am giving you the introduction and then a link:

Prevention and treatment of side-effects of systemic treatment: bone loss

J.-J. Body*

CHU Brugmann, Department of Medicine, Universite ´ Libre de Bruxelles, Brussels, Belgium

Cancer treatment-induced bone loss (CTIBL) is generally more rapid and severe than bone loss associated with menopause in women or ageing in men and women. In premenopausal women with breast cancer, CTIBL is mainly caused by chemotherapy with resultant ovarian failure, by GnRH agonists or by tamoxifen. In postmenopausal women, steroidal and non-steroidal aromatase inhibitors (AIs) increase bone turnover, decrease bone mass and increase fracture rate (hazard ratio increased to 1.38-1.55 compared with tamoxifen). Zoledronic acid can prevent bone loss in premenopausal women receiving adjuvant therapy with goserelin in combination with either anastrozole or tamoxifen and in postmenopausal women receiving AIs. Denosumab has been shown in a placebo-controlled study to significantly increase bone mineral density in postmenopausal women under AIs. More limited studies indicate that oral bisphosphonates used at licensed doses for the treatment of postmenopausal osteoporosis can also prevent AI- induced bone loss. In prostate cancer, bone loss that occurs with androgen deprivation therapy (ADT) also leads to an increased fracture rate. The bisphosphonates pamidronate and alendronate can prevent bone loss whereas zoledronic acid can increase bone mass under ADT. As for breast cancer, delay in bisphosphonate therapy is detrimental to bone health. The protective effects of denosumab on bone loss and incidental vertebral fractures have been demonstrated in a 3-year placebo-controlled trial.