Several breast cancer treatments can cause bone loss, also called osteopenia or osteoporosis:
Still, the very small study reviewed here found that more than 75% of 64 post-menopausal women diagnosed with breast cancer with bone loss had factors besides breast cancer treatment that could contribute to bone loss:
These same factors were seen in the women in the study who had bone loss but weren't treated for breast cancer.
Because these causes of bone loss are treatable, the researchers suggest that women with bone loss during and after breast cancer treatment be evaluated carefully for ALL possible causes of bone loss.
When you're being treated for breast cancer, it might seem like everything affecting your health is related to the breast cancer or its treatment. That's understandable. Still, it's important for you and your doctor to keep an eye on the whole, big picture of your health, including bone health. If you're told that you have bone loss during or after treatment, ask your doctor if ALL the possible causes of bone loss have been considered, including causes not related to cancer treatment. While the bone health effects of breast cancer treatment may not be completely avoidable, other factors that can be treated may be contributing to your bone loss. But these factors can be treated only if they're diagnosed.
The Bone Health section of Breastcancer.org offers detailed information on bone health, how bone health is measured, and how breast cancer treatments can affect bone health, as well as tips to keep your bones as strong as they can be.
MAYWOOD, Ill., Nov. 21 (MedPage Today) -- When assessing bone loss in postmenopausal breast cancer patients, clinicians should look beyond the effects of aromatase inhibitors and other therapies, researchers here said.
Out of 64 breast cancer patients with osteopenia or osteoporosis, 78.1% had a potential cause of bone loss secondary to treatment, aging, or menopause, a prevalence similar to that in women without cancer (77%), Pauline Camacho, M.D., of Loyola University Medical Center, and colleagues reported in the Nov. 20 issue the Journal of Clinical Oncology.
Secondary causes included vitamin D deficiency, idiopathic hypercalciuria, and elevated parathyroid hormone levels.
"The results of our study support the recommendation that postmenopausal patients with breast cancer should undergo metabolic bone evaluation, including a baseline dual energy x-ray absorptiometry scan, as well as a work-up for secondary causes of bone loss," the researchers said.
"This is especially important if they are to be given aromatase inhibitors," they said.
Dr. Camacho and colleagues retrospectively evaluated data from all women who were referred to the Loyola University Osteoporosis and Metabolic Bone Disease Center from 2000 through 2006; 64 had invasive breast cancer and 174 did not.
The cancer-free women were significantly older (64.2 versus 59.5, P=0.015), and had a lower mean body weight (P=0.001), 25-hydroxyvitamin D level (P=0.019), and greater degree of bone loss in the spine (P?0.001) and hip (P=0.004).
Excluding the influence of gonadotropin-releasing hormone, chemotherapy, and aromatase inhibitors, the cancer patients had a nonsignificantly higher occurrence of secondary causes of bone loss (87.5% versus 77.6%, P=0.093).
Newly diagnosed metabolic bone disorders were identified in 57.8% of the cancer patients. The most common were vitamin D deficiency (37.5%), idiopathic hypercalciuria (15.6%), primary hyperparathyroidism (1.6%), and normocalcemic hyperparathyroidism (3.1%).
There was a trend toward a higher rate of vitamin D deficiency in the control patients (51.1% versus 37.5%, P=0.062), even though past studies have reported higher rates of the deficiency in breast cancer patients.
As expected, use of aromatase inhibitors, previous chemotherapy, and use of GnRH analogs were significantly higher in the breast cancer patients (P?0.007 for all).
"Our findings, if prospectively verified, support closer attention to the evaluation and management of bone health in early-stage breast cancer," the researchers said.
"These findings are important in that addressing these secondary causes may limit future morbidity, regardless of whether aromatase inhibitors are used in the care plan," they said.
They noted that many of the secondary causes would not have been identified without a thorough workup.
The authors acknowledged that the study was limited by its retrospective design, possible referral bias, and the significant age difference between the two patient groups.
Future studies, they said, should examine the prevalence of secondary causes of bone loss in a larger population of breast cancer patients and determine the effects of treating those causes on bone mineral density and fracture risk.
The study was supported by a grant from Procter & Gamble.
The authors reported no conflicts of interest.
Primary source: Journal of Clinical Oncology Source reference: Camacho P, et al "Prevalence of secondary causes of bone loss among breast cancer patients with osteopenia and osteoporosis" J Clin Oncol 2008; 26: 5380-5385.
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