MedWire News: Combining bone mineral density (BMD) with clinical risk factors improves the identification of women with breast cancer who are at risk for fracture, German researchers report.
Current guidelines for managing bone health in women with breast cancer recommend the use of BMD measurements to identify candidates for antiresorptive therapy, explain Peyman Hadji and colleagues from Philipps-University of Marburg. However, emerging guidelines include both clinical risk factors and BMD to assess the overall fracture risk.
In the present study, Hadji and team assessed baseline characteristics, fracture risk factors, and lumbar spine and total hip BMD in 88 premenopausal and 402 postmenopausal women with newly diagnosed breast cancer to determine who would receive bisphosphonate therapy based on current and emerging guidelines.
The researchers report that, among patients with estrogen receptor (ER)-positive breast cancer, 18.8% of premenopausal and 36.9% of postmenopausal women were osteopenic at the lumbar spine. The corresponding osteoporosis rates were 0% and 8.9%, respectively.
Stratification of patients by ER status revealed a higher prevalence of lumbar spine osteopenia in premenopausal patients with ER-negative breast cancer, at 18.2% compared with 15.4% for ER-positive breast cancer. In contrast, lumbar spine osteopenia was more prevalent in postmenopausal patients with ER-positive breast cancer, at 35.9% versus 22.4%.in ER-negative breast cancer patients.
Current guidelines based on BMD alone identified 8.9% of ER-positive postmenopausal patients as eligible for antiresorptive therapy, while clinical risk factors alone identified 6.5% of ER-positive postmenopausal as eligible. When the two methods were combined, the researchers found that 28.6% of patients would be eligible for treatment.
Hadji and team estimated that current guidelines prevent only 18% of potential fractures, whereas treatment based on emerging guidelines would prevent approximately 45% of potential fractures.
“Because aromatase inhibitors are associated with increased risks for bone loss and fracture that persist for the duration of treatment, active management of bone health in this patient population is important,” remark Hadji and co-authors in the British Journal of Cancer.
They conclude: “Evaluating both BMD and clinical risk factors may allow more effective identification of breast cancer patients with elevated fracture risk.”
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