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Volume 1, Issue 1 J Nurs Res Pract Nursing Care & Breast Congress 2017
December 11-13, 2017
Page 13
December 11-13, 2017 | Rome, Italy
Joint Event
&
45th WORLD CONGRESS ON NURSING CARE
8TH EUROPEAN BREAST CONGRESS
Peter Schwarz, J Nurs Res Pract 2017, 1:1(Suppl)
Optimal prevention of bone loss due to aromatase inhibitors in early non-metastatic breast cancer
after menopause
Background: Breast cancer (BC) is themost common cancer inwomen. In postmenopausal womenwith estrogen receptor (ER)
dependent BC, anti-hormone therapy is an option with aromatase inhibition (AI), resulting in decreased estrogen production.
Available therapeutic options for management of bone loss in patients receiving AI are zoledronic acid (ZA), risedronate (Ris),
alendronate (Aln) and denosumab (Dmab). Current knowledge on anti-neoplastic effects favors ZA. However in cases of more
severe disease Dmab might be superior.
Methods: In PubMed and Embase, 373 studies were identified on Al treatment and BMD or fracture. In total, 31 RCT studies
was found during the evaluation; ZA 18, Ris 9, Aln 2 and Dmab 2.
Results: Evaluation of ZA treatment showed 18 RCT studies on BMD or fracture. However in several cases the cohorts
were reported on more than once. We found in total 7 cohorts evaluated after 12 to 61 months. In all cohorts the treatment
was ZA acid 8 mg/year vs. placebo (n= 1,551 vs. 1,550). The absolute difference in mean lumbar spine and total hip BMD’s
between patients in treatment or placebo was 8.9% and 5.9%, respectively. None of the studies reported severe side effects. The
evaluation of Ris treatment showed 8 RCT studies on BMD or fracture. However, 1 study was reported only on bone markers.
Of the remaining 7 studies, 2 studies were excluded. The 2 studies excluded were 1 study on a mix of Aln and Ris and 1 study of
6 month length and 2.5 mg Ris per day. The remaining 5 studies reported were 24 month RCT’s. In all 5 studies the treatment
was Ri 35 mg/week vs. placebo (n= 429 vs. 291). The absolute difference in mean lumbar spine and total hip BMD’s between
patients in treatment or placebo was 4.5% and 3.1%, respectively. Two RCT’s are published on Aln of whom only one study had
a long time follow-up (36 months). None of the studies on bisphosphonate reported severe side-effects. Evaluation of Dmab
treatment showed 9 RCT papers where two papers reported on BMD and fracture. These papers were on the same cohort and
they reported on 24 mo of Dmab 60 mg every 6 mo vs. placebo (n= 123 vs. 122) an absolute mean lumbar difference in spine
BMD of 7.6% and no severe side-effects.
Conclusion: Among anti-resorptives, ZA currently has the highest evidence for prevention of Al associated bone loss in
postmenopausal women with early BC. Data on fracture prevention is sparse.
Biography
Peter Schwarz is a Professor at the Department of Endocrinology, Rigshospitalet, Denmark and is covering a broad clinical and laboratory experience from employment
in departments of Internal Medicine and Clinical Biochemistry focusing calcium metabolic diseases and secondary osteoporosis at Copenhagen University. Clinically,
he is a Chief Physician covering especially secondary bone loss and secondary osteoporosis due to treatment of breast cancer treatment. Breast cancer is the most
common cancer in Danish women, and has an average of about 5.000 new cases a year. Patients treated for early (non-metastatic) breast cancer comprise, due to earlier
diagnosis and improved treatment, a large and growing group of cancer survivors. However, many patients experience treatment-related endocrine side-effects such as
reduced bone mineral density, dyslipidemia, insulin resistance and hypertension increasing the risk of bone fractures as well risk of development of metabolic disease. The
research group is focused to understand the underlying physiological and molecular mechanisms responsible for the chemotherapy-induced bone and cardiometabolic
derangements to identify novel disease mechanisms as well as to identify potential biomarkers to be used for better prediction and prevention of metabolic disease.
Targeted exercise training could reduce treatment-related risk of metabolic disease and of bone fractures and the research group aims to investigate the effect of physical
activity on minimizing or reversing treatment-related side-effects. He has published 138 original papers, editorials and reviews and authored 6 book chapters.
Peter Schwarz
Copenhagen University, Denmark