Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Archives of Osteoporosis
Published in: Archives of Osteoporosis 1/2023

01-12-2023 | Breast Cancer | Original Article

Cytotoxic chemotherapy is associated with decreased bone mineral density in postmenopausal women with early and locally advanced breast cancer

Authors: Yadav Nisha, Biswajit Dubashi, Zachariah Bobby, Jaya Prakash Sahoo, Smita Kayal, Ramesh Ananthakrishnan, Prasanth Ganesan

Published in: Archives of Osteoporosis | Issue 1/2023

Login to get access

Abstract

Purpose

The burden and mechanisms of endocrine therapy-related bone loss have been studied in detail. However, there is limited data regarding cytotoxic chemotherapy’s impact on bone health. There are no definitive guidelines for bone mineral density (BMD) monitoring and treatment with bone-modifying agents during cytotoxic chemotherapy. The study’s primary objective was to evaluate the changes in BMD and fracture risk assessment tool (FRAX) scores among breast cancer women on cytotoxic chemotherapy.

Methods

One hundred and nine newly diagnosed early and locally advanced postmenopausal breast cancer patients planned for anthracycline and taxane-based chemotherapy were recruited prospectively during the study period from July 2018 to December 2021. BMD of the lumbar spine, the femoral neck, and the total hip were assessed by dual-energy X-ray absorptiometry scan. BMD and FRAX scores were evaluated at baseline, end of chemotherapy, and 6 months of follow-up.

Results

The median age of the study population was 53 (45–65) years. Early and locally advanced breast cancers were seen in 34 (31.2%) and 75 (68.8%) patients, respectively. The duration of follow-up between two BMD measurements was 6 months. The percentage of decrease in BMD at the lumbar spine, femoral neck, and total hip were − 2.36 ± 2.90, − 2.63 ± 3.79, and − 2.08 ± 2.80, respectively (P-value = 0.0001). The median risk of major osteoporotic fracture (MOF) at 10 years (FRAX score) increased from 1.7 (1.4) to 2.7% (2.4) (P-value = 0.0001).

Conclusion

This prospective study in postmenopausal breast cancer women shows a significant association of cytotoxic chemotherapy with the worsening of bone health in terms of BMD and FRAX score.
Appendix
Available only for authorised users
Literature
1.
Coleman RE, Rathbone E, Brown JE (2013) Management of cancer treatment-induced bone loss. Nat Rev Rheumatol 9(6):365–374CrossRefPubMed
2.
3.
Sànchez-Riera L, Wilson N (2017) Fragility fractures & their impact on older people. Best Pract Res Clin Rheumatol 31(2):169–191CrossRefPubMed
4.
Rosen CJ, Tenenhouse A (1998) Biochemical markers of bone turnover. A look at laboratory tests that reflect bone status. Postgrad Med 104(4):101–2 (107–10 113–4)CrossRefPubMed
5.
Malhotra N, Mithal A (2008) Osteoporosis in Indians. Indian J Med Res 127(3):263–268PubMed
6.
Peppone LJ, Mustian KM, Rosier RN, Carroll JK, Purnell JQ, Janelsins MC (2014) Bone health issues in breast cancer survivors: a Medicare current beneficiary survey (MCBS) study. Support Care Cancer 22(1):245–251CrossRefPubMed
7.
Nisha Y, Dubashi B, Bobby Z, Sahoo JP, Kayal S (2021) Effect of cytotoxic chemotherapy on bone health among breast cancer patients Does it require intervention? Support Care Cancer 29(11):6957–72CrossRefPubMed
8.
Bines J, Oleske DM, Cobleigh MA (1996) Ovarian function in premenopausal women treated with adjuvant chemotherapy for breast cancer. J Am Soc Clin Oncol 14(5):1718–1729CrossRef
9.
Pfeilschifter J, Diel IJ (2000) Osteoporosis due to cancer treatment: pathogenesis and management. J Am Soc Clin Oncol 18(7):1570–1593CrossRef
10.
Oostra DR, Lustberg MB, Reinbolt RE, Pan X, Wesolowski R, Shapiro CL (2015) Association of osteoprotegerin and bone loss after adjuvant chemotherapy in early-stage breast cancer. Mol Cell Endocrinol 15(402):51–56CrossRef
11.
Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Am Soc Bone Miner Res 8(9):1137–1148CrossRef
12.
Shapiro CL, Van Poznak C, Lacchetti C, Kirshner J, Eastell R, Gagel R et al (2019) Management of osteoporosis in survivors of adult cancers with nonmetastatic disease: ASCO clinical practice guideline. J Am Soc Clin Oncol 37(31):2916–2946CrossRef
13.
Hadji P, Body JJ, Aapro MS, Brufsky A, Coleman RE, Guise T et al (2008) Practical guidance for the management of aromatase inhibitor-associated bone loss. Ann Oncol 19(8):1407–1416CrossRefPubMed
14.
Goldhirsch A, Ingle JN, Gelber RD, Coates AS, Thürlimann B, Senn HJ et al (2009) Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the primary therapy of early breast cancer 2009. Ann Oncol 20(8):1319–1329CrossRefPubMedPubMedCentral
15.
Body JJ, Bergmann P, Boonen S, Boutsen Y, Devogelaer JP, Goemaere S et al (2007) Management of cancer treatment-induced bone loss in early breast and prostate cancer – a consensus paper of the Belgian Bone Club. Osteoporos Int 18(11):1439–1450CrossRefPubMed
16.
17.
Garg MK, Kharb S (2013) Dual energy X-ray absorptiometry: pitfalls in measurement and interpretation of bone mineral density. Indian J Endocrinol Metab 17(2):203–210CrossRefPubMedPubMedCentral
18.
Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312(7041):1254–1259CrossRefPubMedPubMedCentral
19.
20.
Fan C, Georgiou KR, McKinnon RA, Keefe DMK, Howe PRC, Xian CJ (2016) Combination chemotherapy with cyclophosphamide, epirubicin and 5-fluorouracil causes trabecular bone loss, bone marrow cell depletion and marrow adiposity in female rats. J Bone Miner Metab 34(3):277–290CrossRefPubMed
21.
22.
Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301(5):513–521CrossRefPubMed
Metadata
Title
Cytotoxic chemotherapy is associated with decreased bone mineral density in postmenopausal women with early and locally advanced breast cancer
Authors
Yadav Nisha
Biswajit Dubashi
Zachariah Bobby
Jaya Prakash Sahoo
Smita Kayal
Ramesh Ananthakrishnan
Prasanth Ganesan
Publication date
01-12-2023
Publisher
Springer London
Published in
Archives of Osteoporosis / Issue 1/2023
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-023-01231-z

Other articles of this Issue 1/2023

Archives of Osteoporosis 1/2023 Go to the issue

Original Article

Admission screening form and osteoporosis educational appointment: a novel fracture liaison service system for identifying osteoporosis patients and facilitating medication initiation

Original Article

The osteoporosis treatment gap in Switzerland between 1998 and 2018

Original Article

Cost-effectiveness of selective bone densitometry using the osteoporosis self-assessment tool for Asians in multi-ethnic Asian population

Original Article

Cumulated ambulation score in hospitalized patients with osteoporotic vertebral fractures is an important predictor of returning home: a retrospective cohort study

Original Article

Data-driven development of the nationwide hip fracture registry in the Netherlands

Original Article

Epidemiology of fragility fracture of the pelvic ring: a regional population-based study in Northern Japan