Web of Science: 38 cites, Scopus: 45 cites, Google Scholar: cites,
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
Hadji, Peyman (Krankenhaus Nordwest)
Aapro, Matti S. (Genolier Cancer Center, Switzerland)
Body, Jean-Jacques (CHU Brugmann, Université Libre de Bruxelles, Belgium)
Gnant, Michael (Medical University of Vienna, Austria)
Brandi, Maria Luisa (University of Florence, Italy)
Reginster, Jean Yves (University of Liège, Belgium)
Zillikens, M. Carola (Erasmus MC, Rotterdam, Netherlands)
Glüer, Claus-C. (Univeristy of Kiel, Germany)
de Villiers, Tobie (University of Stellenbosch, Cape Town, South Africa)
Baber, Rod (University of Sydney, Australia)
Roodman, G. David (Indiana University School of Medicine, USA)
Cooper, Cyrus (University of Southampton, UK)
Langdahl, Bente (Aarhus University, Denmark)
Palacios, Santiago (Instituto Palacios Madrid, Spain)
Kanis, John (Catholic University of Australia, Melbourne, Australia and University of Sheffield, UK)
Al-Daghri, Nasser (University of Riyadh, Saudi Arabia)
Nogués Solán, Xavier (Universitat Autònoma de Barcelona)
Eriksen, Erik Fink (University of Oslo, Norway)
Kurth, Andreas (Klinikum Birkenwerder, Germany)
Rizzoli, Rene (Geneva University, Switzerland)
Coleman, Robert E. (University of Sheffield, UK)

Data: 2017
Resum: Several guidelines have been reported for bone-directed treatment in women with early breast cancer (EBC) for averting fractures, particularly during aromatase inhibitor (AI) therapy. Recently, a number of studies on additional fracture related risk factors, new treatment options as well as real world studies demonstrating a much higher fracture rate than suggested by randomized clinical controlled trials (RCTs). Therefore, this updated algorithm was developed to better assess fracture risk and direct treatment as a position statement of several interdisciplinary cancer and bone societies involved in the management of AI-associated bone loss (AIBL). A systematic literature review identified recent advances in the management of AIBL. Results with individual agents were assessed based on trial design, size, follow-up, and safety. Several fracture related risk factors in patients with EBC were identified. Although, the FRAX algorithm includes fracture risk factors (RF) in addition to BMD, it does not seem to adequately address the effects of AIBL. Several antiresorptive agents can prevent and treat AIBL. However, concerns regarding compliance and long-term safety remain. Overall, the evidence for fracture prevention is strongest for denosumab 60 mg s. c. every 6 months. Additionally, recent studies as well as an individual patient data meta-analysis of all available randomized trial data support additional anticancer benefits from adjuvant bisphosphonate treatment in postmenopausal women with a 34% relative risk reduction in bone metastasis and 17% relative risk decrease in breast cancer mortality that needs to be taken into account when advising on management of AIBL. In all patients initiating AI treatment, fracture risk should be assessed and recommendation with regard to exercise and calcium/vitamin D supplementation given. Bone-directed therapy should be given to all patients with a T-score<−2. 0 or with a T-score of <–1. 5 SD with one additional RF, or with ≥2 risk factors (without BMD) for the duration of AI treatment. Patients with T-score>−1. 5 SD and no risk factors should be managed based on BMD loss during the first year and the local guidelines for postmenopausal osteoporosis. Compliance should be regularly assessed as well as BMD on treatment after 12 - 24 months. Furthermore, because of the decreased incidence of bone recurrence and breast cancer specific mortality, adjuvant bisphosphonates are recommended for all postmenopausal women at significant risk of disease recurrence.
Drets: Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades. Creative Commons
Llengua: Anglès.
Document: article ; recerca ; publishedVersion
Matèria: Breast cancer ; Osteoporosis ; Endocrine treatment ; Fracture ; Bisphosphonate ; Denosumab
Publicat a: Journal of Bone Oncology, Vol. 7 (June 2017) , p. 1-12, ISSN 2212-1374

PMID: 28413771
DOI: 10.1016/j.jbo.2017.03.001


12 p, 675.8 KB

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