Cancer treatment-induced bone loss in premenopausal women

A need for therapeutic intervention?

P. Hadji, M. Gnant, J. J. Body, N. J. Bundred, A. Brufsky, R. E. Coleman, Theresa Guise, A. Lipton, M. S. Aapro

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)798-806
Number of pages9
JournalCancer Treatment Reviews
Volume38
Issue number6
DOIs
StatePublished - Oct 2012

Fingerprint

Bone and Bones
Neoplasms
Breast Neoplasms
Therapeutics
Diphosphonates
Vitamin D
Bone Density
Estrogens
Premature Menopause
Calcium
Drug Therapy
Amenorrhea
Photon Absorptiometry
Health
Clinical Trials
Guidelines
Exercise

Keywords

  • Amenorrhea
  • Antiresorptive
  • Bisphosphonate
  • Bone loss
  • Breast cancer
  • Premenopausal

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Hadji, P., Gnant, M., Body, J. J., Bundred, N. J., Brufsky, A., Coleman, R. E., ... Aapro, M. S. (2012). Cancer treatment-induced bone loss in premenopausal women: A need for therapeutic intervention? Cancer Treatment Reviews, 38(6), 798-806. https://doi.org/10.1016/j.ctrv.2012.02.008

Cancer treatment-induced bone loss in premenopausal women : A need for therapeutic intervention? / Hadji, P.; Gnant, M.; Body, J. J.; Bundred, N. J.; Brufsky, A.; Coleman, R. E.; Guise, Theresa; Lipton, A.; Aapro, M. S.

In: Cancer Treatment Reviews, Vol. 38, No. 6, 10.2012, p. 798-806.

Research output: Contribution to journalArticle

Hadji, P, Gnant, M, Body, JJ, Bundred, NJ, Brufsky, A, Coleman, RE, Guise, T, Lipton, A & Aapro, MS 2012, 'Cancer treatment-induced bone loss in premenopausal women: A need for therapeutic intervention?', Cancer Treatment Reviews, vol. 38, no. 6, pp. 798-806. https://doi.org/10.1016/j.ctrv.2012.02.008
Hadji, P. ; Gnant, M. ; Body, J. J. ; Bundred, N. J. ; Brufsky, A. ; Coleman, R. E. ; Guise, Theresa ; Lipton, A. ; Aapro, M. S. / Cancer treatment-induced bone loss in premenopausal women : A need for therapeutic intervention?. In: Cancer Treatment Reviews. 2012 ; Vol. 38, No. 6. pp. 798-806.
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