The Use of Bisphosphonates in Patients With Breast Cancer

Catherine H. Van Poznak, MD

Disclosures

Cancer Control. 2002;9(6) 

In This Article

Osteopenia and Osteoporosis in Breast Cancer Patients

Osteoporosis, primary or secondary, is often a comorbid condition in patients with breast cancer. The antineoplastic therapy for breast cancer can itself have adverse effects on bone.[46] Chemotherapy can have direct negative effects on bone mineral density, as can the glucocorticoids used as antiemetics and premedications. Adjuvant chemotherapy can cause premature menopause and increased risk for osteoporosis. Hormonal replacement therapy is commonly used for prevention and treatment of osteoporosis. However, this intervention is controversial in women with a history of breast cancer and is generally not an accepted option in this patient population.[47] Osteoporosis can be both prevented and treated with bisphosphonates. In conjunction with calcium, vitamin D, and weight-bearing exercise, bisphosphonate therapy may be considered in women who are at risk for osteopenia or osteoporosis. Selecting interventions for the treatment of osteoporosis is influenced by the patients' prior history of breast cancer, as well as the conflicting data on adjuvant use of bisphosphonates. Agents to consider in the treatment of low bone mineral density in patients with breast cancer include selective estrogen receptor modulators, bisphosphonates, calcitonin, or clinical trials exploring novel therapies such as parathyroid hormone and monoclonal antibodies targeting signaling through osteoprotegerin or its ligand.

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