Rebecca Pedersini1, Sara Monteverdi1, Gherardo Mazziotti2, Vito Amoroso3, Elisa Roca4, Filippo Maffezzoni5, Lucia Vassalli1, Filippo Rodella1, Anna Maria Formenti5, Stefano Frara6, Roberto Maroldi7, Alfredo Berruti4, Edda Simoncini8, Andrea Giustina6. 1. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili Hospital, Medical Oncology Unit, Brescia, Italy; Breast Unit, Spedali Civili Hospital, Brescia, Italy. 2. Endocrine and Bone Unit, Department of Medicine, ASST "Carlo Poma", Mantova, Italy. 3. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili Hospital, Medical Oncology Unit, Brescia, Italy. Electronic address: vitoamoroso@alice.it. 4. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili Hospital, Medical Oncology Unit, Brescia, Italy. 5. Department of Molecular and Translational Medicine, University of Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili Hospital, Radiology Unit, Brescia, Italy. 6. Endocrinology, San Raffaele Vita-Salute University, Milan, Italy. 7. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili Hospital, Radiology Unit, Brescia, Italy. 8. Breast Unit, Spedali Civili Hospital, Brescia, Italy.
Abstract
BACKGROUND: The impact of long-term adjuvant therapy with aromatase inhibitors (AIs) on vertebral fracture (VF) risk is still unclear. OBJECTIVE: In this cross-sectional study, we explored the prevalence and determinants of VFs in breast cancer (BC) patients before and during AI therapy. Each woman underwent a dual-energy X-ray absorptiometry (DXA) to evaluate bone mineral density (BMD) and identify VFs by a quantitative morphometric approach. Blood samples were collected to measure serum hormone and calcium levels. RESULTS: We consecutively included 263 postmenopausal women with hormone receptor-positive early BC. One-hundred-sixty-nine women were AI-naïve, and 94 were AI-treated. AI-treated patients had lower BMD at total hip (p=0.01) and lumbar spine (p=0.03), higher serum vitamin D (p<0.001) and parathyroid hormone (p=0.006) values as compared to AI-naïve patients. The prevalence of VFs was 18.9% in AI-naïve patients, and 31.2% in those assessed during AI therapy (odds ratio 1.90, 95% CI 1.1-3.5, p=0.03). In AI-naïve patients, VFs were associated with older age (p=0.002) and lower BMD values at femoral neck (p=0.04) and total hip (p=0.007), whereas VFs occurred without association with any parameter analyzed in AI-treated patients. In AI-treated group, the prevalence of VFs was not significantly different between patients with osteoporosis and those with normal BMD (36.7% vs. 20.0%; p=0.31). CONCLUSIONS: In women with early BC, AI therapy is associated with high prevalence of radiological VFs, which were shown to be independent of BMD values during the adjuvant treatment. These findings may be clinically relevant since they may lead to a change in management of AI-induced skeletal fragility. Specifically, the results of this study provide a rationale for performing a morphometric evaluation of VFs in all women undergoing treatment with AIs.
BACKGROUND: The impact of long-term adjuvant therapy with aromatase inhibitors (AIs) on vertebral fracture (VF) risk is still unclear. OBJECTIVE: In this cross-sectional study, we explored the prevalence and determinants of VFs in breast cancer (BC) patients before and during AI therapy. Each woman underwent a dual-energy X-ray absorptiometry (DXA) to evaluate bone mineral density (BMD) and identify VFs by a quantitative morphometric approach. Blood samples were collected to measure serum hormone and calcium levels. RESULTS: We consecutively included 263 postmenopausal women with hormone receptor-positive early BC. One-hundred-sixty-nine women were AI-naïve, and 94 were AI-treated. AI-treated patients had lower BMD at total hip (p=0.01) and lumbar spine (p=0.03), higher serum vitamin D (p<0.001) and parathyroid hormone (p=0.006) values as compared to AI-naïve patients. The prevalence of VFs was 18.9% in AI-naïve patients, and 31.2% in those assessed during AI therapy (odds ratio 1.90, 95% CI 1.1-3.5, p=0.03). In AI-naïve patients, VFs were associated with older age (p=0.002) and lower BMD values at femoral neck (p=0.04) and total hip (p=0.007), whereas VFs occurred without association with any parameter analyzed in AI-treated patients. In AI-treated group, the prevalence of VFs was not significantly different between patients with osteoporosis and those with normal BMD (36.7% vs. 20.0%; p=0.31). CONCLUSIONS: In women with early BC, AI therapy is associated with high prevalence of radiological VFs, which were shown to be independent of BMD values during the adjuvant treatment. These findings may be clinically relevant since they may lead to a change in management of AI-induced skeletal fragility. Specifically, the results of this study provide a rationale for performing a morphometric evaluation of VFs in all women undergoing treatment with AIs.
Authors: H Che; V Breuil; B Cortet; J Paccou; T Thomas; L Chapuis; F Debiais; N Mehsen-Cetre; R M Javier; S Loiseau Peres; C Roux; K Briot Journal: Osteoporos Int Date: 2018-12-05 Impact factor: 4.507
Authors: G Mazziotti; A M Formenti; M B Panarotto; E Arvat; A Chiti; A Cuocolo; M E Dottorini; C Durante; L Agate; S Filetti; F Felicetti; A Filice; L Pace; T Pellegrino; M Rodari; M Salvatori; C Tranfaglia; A Versari; D Viola; S Frara; A Berruti; A Giustina; R Giubbini Journal: Endocrine Date: 2017-11-06 Impact factor: 3.633
Authors: Komal Waqas; Joana Lima Ferreira; Elena Tsourdi; Jean-Jacques Body; Peyman Hadji; M C Zillikens Journal: J Bone Oncol Date: 2021-03-18 Impact factor: 4.072
Authors: Rebecca Pedersini; Vito Amoroso; Filippo Maffezzoni; Fabio Gallo; Antonella Turla; Sara Monteverdi; Mara Ardine; Marco Ravanelli; Lucia Vassalli; Filippo Rodella; Anna Maria Formenti; Alberto Dalla Volta; Edda Lucia Simoncini; Andrea Giustina; Roberto Maroldi; Alfredo Berruti Journal: JAMA Netw Open Date: 2019-09-04