What are bone health considerations in breast cancer management?

Updated: Nov 06, 2019
  • Author: Winston W Tan, MD, FACP; Chief Editor: Marie Catherine Lee, MD, FACS  more...
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Answer

Answer

Attention to bone health is an important aspect of managing breast cancer in women. Many women with breast cancer are postmenopausal and, therefore, at increased risk for osteoporosis. In addition, some of the agents used for the treatment of breast cancer have adverse effects on bone. For example, aromatase inhibitors (eg, anastrozole, letrozole, exemestane), which are used to treat early-stage breast cancer in postmenopausal women, deplete bone.

Finally, bone is the most common site of metastasis in breast cancer. Metastasis to bone causes pain, pathological fractures, hypercalcemia, and spinal cord compression, as well as contributing to mortality. [1, 2]

A study by Lipton et al found that in patients with bone-only metastases, serum beta C-terminal telopeptide (B-CTx) of type I collagen was a significant predictor of shortened recurrence-free survival (RFS). B-CTx is a marker of bone resorption, and increased resorption favors the growth of cancer cells. [3]

Increasing evidence indicates that in postmenopausal women with breast cancer, adjuvant bisphosphonate treatment not only improves bone density but also decreases bone metastasis and improves overall survival. In patients with metastatic breast cancer, bisphosphonates and denosumab have been shown to decrease skeletal-related events, including fractures; hypercalcemia; and increased need for radiation, surgery, or pain medication.

For more information, see Breast Cancer, Breast Cancer Staging, Adjuvant Therapy for Breast Cancer, and Breast Cancer Treatment Protocols.


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