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Bone health care in women with breast cancer

Paschou SΑ1Augoulea A1Lambrinoudaki I2.

Hormones (Athens). 2019 Dec 18. doi: 10.1007/s42000-019-00164-y. [Epub ahead of print]

 

 

Abstract

The aim of this article is to analyze and critically appraise the literature regarding optimal bone health care in women with breast cancer and, more specifically, to present (1) the causes of bone loss in breast cancer patients, (2) the appropriate screening for osteoporosis and fracture risk estimation, (3) optimal prevention and therapeutic strategies for osteoporosis and fractures, (4) the role of antiresorptive agents as adjuvant therapy for the prevention of bone metastases and increase of overall survival, and (5) current data on the possible use of menopausal hormone therapy (MHT) in these patients. The objective is to provide a sound pathophysiological background along with evidence-based and practical recommendations for physicians managing such women.

Conclusions Bone loss in women with breast cancer is multifactorial and quite common. All women should be carefully evaluated at baseline for fracture risk, while in most of them, BMD should also measured. All these patients should be advised to follow lifestyle changes that favor their bone health, such as calcium and vitamin D supplementation, smoking cessation, reduction of alcohol consumption, and regular weight-bearing exercise. Pharmacological intervention is needed for those with a Tscore ≤ − 2 or with two or more clinical risk factors for fracture. Bisphosphonates and zoledronic acid for premenopausal women and any regimen for postmenopausal women or denosumab for postmenopausal women should be used (Table 2). Treatment should be continued at least until the adjuvant breast cancer treatment program is complete. Last but not least, the perspectives regarding the use of these agents for improvement of long-term health outcomes are exciting.