Bone loss during neoadjuvant/adjuvant chemotherapy for early stage breast cancer: A retrospective cohort study

Tang Axelsen,Christian; Bonde Jensen,Anders; Hugger Jakobsen,Erik; Bechmann,Troels

doi:10.3892/mco.2018.1615

June-2018 Volume 8 Issue 6

Full Size Image

Journals

International Journal of Molecular Medicine

International Journal of Molecular Medicine is an international journal devoted to molecular mechanisms of human disease.

International Journal of Oncology

International Journal of Oncology is an international journal devoted to oncology research and cancer treatment.

Molecular Medicine Reports

Covers molecular medicine topics such as pharmacology, pathology, genetics, neuroscience, infectious diseases, molecular cardiology, and molecular surgery.

Oncology Reports

Oncology Reports is an international journal devoted to fundamental and applied research in Oncology.

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine is an international journal devoted to laboratory and clinical medicine.

Oncology Letters

Oncology Letters is an international journal devoted to Experimental and Clinical Oncology.

Biomedical Reports

Explores a wide range of biological and medical fields, including pharmacology, genetics, microbiology, neuroscience, and molecular cardiology.

Molecular and Clinical Oncology

International journal addressing all aspects of oncology research, from tumorigenesis and oncogenes to chemotherapy and metastasis.

World Academy of Sciences Journal

Multidisciplinary open-access journal spanning biochemistry, genetics, neuroscience, environmental health, and synthetic biology.

International Journal of Functional Nutrition

Open-access journal combining biochemistry, pharmacology, immunology, and genetics to advance health through functional nutrition.

International Journal of Epigenetics

Publishes open-access research on using epigenetics to advance understanding and treatment of human disease.

Medicine International

An International Open Access Journal Devoted to General Medicine.

June-2018 Volume 8 Issue 6

Full Size Image

Article

Bone loss during neoadjuvant/adjuvant chemotherapy for early stage breast cancer: A retrospective cohort study

Authors:
- Christian Tang Axelsen
- Anders Bonde Jensen
- Erik Hugger Jakobsen
- Troels Bechmann
View Affiliations / Copyright

Affiliations: Institute of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark, Department of Oncology, Lillebaelt Hospital, 7100 Vejle, Denmark
Pages: 767-772
|
Published online on: April 24, 2018

https://doi.org/10.3892/mco.2018.1615
Expand metrics +

Abstract

The present study aimed to evaluate the extent of loss in bone mineral density (BMD) during neoadjuvant and adjuvant chemotherapy for early stage breast cancer. A retrospective cohort study was conducted to quantify the loss of BMD one year following the start of chemotherapy and to identify potential risk factors of excessive BMD loss. Based on DXA‑scans prior to and one year following chemotherapy, the loss of BMD was evaluated in early stage breast cancer patients treated from January 2012 to December 2014. A total of 492 patients received either eight cycles of neoadjuvant or six cycles of adjuvant chemotherapy. The final analysis included 152 patients with two DXA‑scans. The patients had a significant loss of BMD in the hip [‑0.0124 g/cm2 (95% confidence interval (CI) ‑0.018; ‑0.007) P<0.001] and in the lumbar spine [‑0.029 g/cm2 (95% CI: ‑0.036; ‑0.023) P<0.001] corresponding to a change of ‑1, 3 and ‑2, 9%, respectively. Premenopausal women had a significant loss of BMD in the lumbar spine ‑0.045 g/cm2 equivalent to ‑4.3%, which was significantly increased compared with postmenopausal women (P<0.001) in the univariate analysis, whereas only a trend persisted in the multivariate analysis (P=0.60). There was no significant difference in BMD loss (lumbar spine P=0.176) between patients receiving adjuvant and neoadjuvant chemotherapy. In conclusion, neoadjuvant and adjuvant chemotherapy is associated with significant BMD loss in both hip and lumbar spine. Furthermore, the results of the present study indicate that premenopausal women have a pronounced BMD loss in the lumbar spine. Further studies investigating osteoporosis prophylaxis in premenopausal patients are warranted.

View Figures

View References

1	Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D and Bray F: Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 136:E359–E386. 2015. View Article : Google Scholar : PubMed/NCBI
2	Engholm G, Ferlay J, Christensen N, Kejs AMT, Hertzum-Larsen R, Johannesen TB, Khan S, Leinonen MK, Ólafsdóttir E, Petersen T, et al: 2016 NORDCAN: Cancer Incidence, Mortality, Prevalence and Survival in the Nordic Countries, Version 7.3 (08.07.2016). Association of the Nordic Cancer Registries. Danish Cancer Society. http://www.ancr.nuMarch 19–2017
3	Hadji P: Cancer treatment-induced bone loss in women with breast cancer. Bonekey Rep. 4:6922015. View Article : Google Scholar : PubMed/NCBI
4	Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B and Kanis JA: Osteoporosis in the European Union: Medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 8:1362013. View Article : Google Scholar : PubMed/NCBI
5	Cameron DA, Douglas S, Brown JE and Anderson RA: Bone mineral density loss during adjuvant chemotherapy in pre-menopausal women with early breast cancer: Is it dependent on oestrogen deficiency? Breast Cancer Res Treat. 123:805–814. 2010. View Article : Google Scholar : PubMed/NCBI
6	Hershman DL, McMahon DJ, Crew KD, Shao T, Cremers S, Brafman L, Awad D and Shane E: Prevention of bone loss by zoledronic acid in premenopausal women undergoing adjuvant chemotherapy persist up to one year following discontinuing treatment. J Clin Endocrinol Metab. 95:559–566. 2010. View Article : Google Scholar : PubMed/NCBI
7	Canalis E, Mazziotti G, Giustina A and Bilezikian JP: Glucocorticoid-induced osteoporosis: Pathophysiology and therapy. Osteoporos Int. 18:1319–1328. 2007. View Article : Google Scholar : PubMed/NCBI
8	Christensen CØ, Cronin-Fenton D, Frøslev T, Hermann AP and Ewertz M: Change in bone mineral density during adjuvant chemotherapy for early-stage breast cancer. Support Care Cancer. 24:4229–4236. 2016. View Article : Google Scholar : PubMed/NCBI
9	Kalder M and Hadji P: Breast cancer and osteoporosis-management of cancer treatment-induced bone loss in postmenopausal women with breast cancer. Breast Care (Basel). 9:312–317. 2014. View Article : Google Scholar : PubMed/NCBI
10	Greep NC, Giuliano AE, Hansen NM, Taketani T, Wang HJ and Singer FR: The effects of adjuvant chemotherapy on bone density in postmenopausal women with early breast cancer. Am J Med. 114:653–659. 2003. View Article : Google Scholar : PubMed/NCBI
11	Bjarnason NH, Hitz M, Jorgensen NR and Vestergaard P: Adverse bone effects during pharmacological breast cancer therapy. Acta Oncol. 47:747–754. 2008. View Article : Google Scholar : PubMed/NCBI
12	Chen Y, Xu G and Yang F: Effect of neoadjuvant chemotherapy on the serum levels of bone turnover markers in women with early-stage breast cancer. PLoS One. 10:e01260532015. View Article : Google Scholar : PubMed/NCBI
13	Hadji P: Aromatase inhibitor-associated bone loss in breast cancer patients is distinct from postmenopausal osteoporosis. Crit Rev Oncol Hematol. 69:73–82. 2009. View Article : Google Scholar : PubMed/NCBI
14	Eastell R, Adams JE, Coleman RE, Howell A, Hannon RA, Cuzick J, Mackey JR, Beckmann MW and Clack G: Effect of anastrozole on bone mineral density: 5-year results from the anastrozole, tamoxifen, alone or in combination trial 18233230. J Clin Oncol. 26:1051–1057. 2008. View Article : Google Scholar : PubMed/NCBI
15	Kanis JA, McCloskey EV, Powles T, Paterson AH, Ashley S and Spector T: A high incidence of vertebral fracture in women with breast cancer. Br J Cancer. 79:1179–1181. 1999. View Article : Google Scholar : PubMed/NCBI
16	Love RR, Mazess RB, Barden HS, Epstein S, Newcomb PA, Jordan VC, Carbone PP and DeMets DL: Effects of tamoxifen on bone mineral density in postmenopausal women with breast cancer. N Engl J Med. 326:852–856. 1992. View Article : Google Scholar : PubMed/NCBI
17	Yoneda K, Tanji Y, Ikeda N, Miyoshi Y, Taguchi T, Tamaki Y and Noguchi S: Influence of adjuvant tamoxifen treatment on bone mineral density and bone turnover markers in postmenopausal breast cancer patients in Japan. Cancer Lett. 186:223–230. 2002. View Article : Google Scholar : PubMed/NCBI
18	Vehmanen L, Elomaa I, Blomqvist C and Saarto T: Tamoxifen treatment after adjuvant chemotherapy has opposite effects on bone mineral density in premenopausal patients depending on menstrual status. J Clin Oncol. 24:675–680. 2006. View Article : Google Scholar : PubMed/NCBI
19	Early Breast Cancer Trialists Collaborative Group (EBCTCG): Adjuvant bisphosphonate treatment in early breast cancer: Meta-analyses of individual patient data from randomised trials. Lancet. 386:1353–1361. 2015. View Article : Google Scholar : PubMed/NCBI
20	Shapiro CL, Manola J and Leboff M: Ovarian failure after adjuvant chemotherapy is associated with rapid bone loss in women with early-stage breast cancer. J Clin Oncol. 19:3306–3311. 2001. View Article : Google Scholar : PubMed/NCBI
21	Hadji P, Gnant M, Body JJ, Bundred NJ, Brufsky A, Coleman RE, Guise TA, Lipton A and Aapro MS: Cancer treatment-induced bone loss in premenopausal women: A need for therapeutic intervention? Cancer Treat Rev. 38:798–806. 2012. View Article : Google Scholar : PubMed/NCBI
22	Garg MK and Kharb S: Dual energy X-ray absorptiometry: Pitfalls in measurement and interpretation of bone mineral density. Indian J Endocrinol Metab. 17:203–210. 2013. View Article : Google Scholar : PubMed/NCBI
23	Marshall D, Johnell O and Wedel H: Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 312:1254–1259. 1996. View Article : Google Scholar : PubMed/NCBI
24	Riggs BL, Khosla S and Melton LJ III: Sex steroids and the construction and conservation of the adult skeleton. Endocr Rev. 23:279–302. 2002. View Article : Google Scholar : PubMed/NCBI
25	Hershman DL, McMahon DJ, Crew KD, Cremers S, Irani D, Cucchiara G, Brafman L and Shane E: Zoledronic acid prevents bone loss in premenopausal women undergoing adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol. 26:4739–4745. 2008. View Article : Google Scholar : PubMed/NCBI