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Vol. 15. Issue 4.
Pages 211-217 (July - August 2019)
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Vol. 15. Issue 4.
Pages 211-217 (July - August 2019)
Original Article
DOI: 10.1016/j.reumae.2017.08.007
Impact of an osteoporosis specialized unit on bone health in breast cancer survivals treated with aromatase inhibitors
Impacto de una unidad de osteoporosis en la salud ósea de pacientes con cáncer de mama en tratamiento con inhibidores de la aromatasa
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Purificación Martíneza,
Corresponding author
pmdelprado@gmail.com

Corresponding author.
, Elena Galvea, Virginia Arrazubia, M. Ángeles Salaa, Seila Fernándeza, Clara E. Pérezb, Juan F. Arangoa, Iñaki Torreb
a Oncology Service, Hospital Universitario Basurto (OSI Bilbao-Basurto), Spain
b Rheumatology Service, Hospital Universitario Basurto (OSI Bilbao-Basurto), Spain
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Table 1. Risk factors in study sample.a
Table 2. Aromatase inhibitors treatment.
Table 3. Bone mineral density (BMD) measurements at baseline and at the end of the follow-up period. Results are presented as mean g/cm2 (T-score).
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Abstract
Objective

Considering the increased fracture risk in early breast cancer patients treated with aromatase inhibitors (AI), we assessed the impact of a preventive intervention conducted by a specialized osteoporosis unit on bone health at AI treatment start.

Material and methods

Retrospective cohort of postmenopausal women who started treatment with AI after breast cancer surgical/chemotherapy treatment and were referred to the osteoporosis unit for a comprehensive assessment of bone health. Bone densitometry and fracture screening by plain X-ray were performed at the baseline visit and once a year for 5 years.

Results

The final record included 130 patients. At AI treatment start, 49% had at least one high-risk factor for fractures, 55% had osteopenia, and 39% osteoporosis. Based on the baseline assessment, 79% of patients initiated treatment with bisphosphonates, 88% with calcium, and 79% with vitamin D. After a median of 65 (50–77) months, 4% developed osteopenia or osteoporosis, and 14% improved their densitometric diagnosis. Fifteen fractures were recorded in 11 (8.5%) patients, all of them receiving preventive treatment (10 with bisphosphonates). During the follow-up period, patients with one or more high-risk factors for fracture showed a greater frequency of fractures (15% vs. 3%) and experienced the first fracture earlier than those without high-risk factors (mean of 99 and 102 months, respectively; P=0.023).

Conclusions

The preventive intervention of a specialized unit at the start of AI treatment in breast cancer survivors allows the identification of patients with high fracture risk and may contribute to preventing bone events in these patients.

Keywords:
Osteoporosis
Bone fractures
Preventive medicine
Aromatase inhibitors
Breast neoplasms
Resumen
Objetivo

Evaluar el impacto de la intervención preventiva de una unidad de osteoporosis en supervivientes de cáncer de mama que inician un tratamiento con inhibidores de la aromatasa (IA).

Material y métodos

Estudio retrospectivo en mujeres posmenopáusicas con cáncer de mama precoz que iniciaron un tratamiento con IA tras la cirugía y/o quimioterapia, derivadas a la unidad de osteoporosis para una evaluación de la salud ósea, incluyendo densitometrías óseas y búsqueda sistemática de fracturas mediante Rx al inicio del tratamiento y anualmente durante 5 años.

Resultados

Se incluyeron 130 pacientes. Al inicio del tratamiento con IA el 49% tenía al menos un factor de riesgo alto para fracturas, el 55% osteopenia y el 39% osteoporosis. Tras la evaluación inicial, el 79% de las pacientes inició un tratamiento con bifosfonatos, el 88% con calcio y el 79% con vitamina D. Tras una mediana de 65 (50-77) meses, el 4% desarrolló osteopenia u osteoporosis y el 14% mejoró el diagnóstico densitométrico. Se registraron 15 fracturas en 11 (8,5%) pacientes, todas ellas en tratamiento preventivo. Durante el seguimiento, las pacientes con ≥1 factores de riesgo altos registraron una mayor frecuencia de fracturas (15 vs. 3%) y un menor tiempo hasta la primera fractura (media de 99 vs. 102 meses; p=0,023).

Conclusiones

La intervención preventiva de una unidad de osteoporosis al inicio del tratamiento con IA en supervivientes de cáncer de mama permite identificar pacientes con un elevado riesgo de fracturas y puede contribuir a la prevención de eventos óseos en estas pacientes.

Palabras clave:
Osteoporosis
Fracturas óseas
Medicina preventiva
Inhibidores de la aromatasa
Cáncer de mama

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