Background/Purpose:  Women with breast cancer are at an increased risk for the development of bone loss and osteoporosis mainly due to adjuvant therapies, such as aromatase inhibitors (AI). AI therapy fully suppresses estrogen synthesis, further exacerbating the increased bone resorption and leading to an excess fracture risk. Thus, a close monitoring of bone mineral metabolism is recommended in these cases. The aim of the present study was to analyze bone health status and clinical characteristics of women with breast cancer referred by oncologist to a specialized clinic and their outcomes during follow-up.

Methods:  Retrospective analysis of consecutive female patients with recent breast cancer (BC) and low bone mineral density (BMD) referred to the osteoporosis outpatient clinic for assessment, as agreed with oncologists. A descriptive analysis of epidemiological, clinical, laboratory, imaging, and dual energy x-ray absorptiometry (DEXA) data is presented, both at baseline and last visit. 95% confidence intervals (95%CI) were estimated for rate of fragility fractures (FF) at baseline and during follow-up.

Results:  A total number of 122 female patients have been assessed up to May 2016; median aged 60.9 (SD±10.6) years old, 91.5% postmenopausal. BC was non-methastasic in 89 (70.3%), and 89 (70.3%) patients were on aromatase inhibitors (66 on letrozole). At baseline, 26 patients (21.0%, 95CI% 20.9-21.1) had previous FF, mostly vertebral (13) or non-vertebral (9), and two cases had suffered from multiple FF. BMDs were at osteoporotic range at the lumbar spine and osteopenic at both the femoral neck and hip. Median 25-hydroxyvitamin D levels were 23.9ng/mL (p25-75 18.1-45.1) at baseline. Regarding antiosteoporotic therapies, bisphosphonates were prescribed in 62 cases (66.6%), denosumab in 16 (17.2%), and raloxifene in one case (1.0%); the others were only on calcium plus vitamin D supplementation. A total of 102 patients were followed a median of 1.5 years (0.8-2.5), and 20 (16%) discontinued controls. During follow-up, new FF occurred in nine patients (9.0%, 95%CI 8.9-9.1), that were vertebral in 6, non-vertebral in 2, both in one case, while no hip FF were detected.

Conclusion:  The outcomes of a structured assessment of female patients with BC and low BMD are reported here. Despite this, almost 10% of cases developed a new FF, highlighting the need for special attention to this singular, secondary form of osteoporosis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/osteoporosis-and-breast-cancer-outcomes-at-a-specialized-osteoporosis-clinic-following-a-structured-assessment/