Biphopsphonates for osteoporosis in breat cancer – pro

Prolia or Zometa can be used for prevention or treatment of Osteoporosis1. , Osteoporosis is often a comorbid condition in patients with breast cancer. The antineoplastic therapy for breast cancer can itself have adverse effects on bone. 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 treatmetn with aromatase inhibitore can cause or aggravate osteoporosis. Osteoporosis can be both prevented and treated with bisphosphonates.

As an update to their earlier publication, the American Society of Clinical Oncology (ASCO) has recently published clinical practice guidelines on the role of bisphosphonates and bone health issues for women with breast cancer. The guidelines committee stated, “Oncology professionals, especially medical oncologists, need to take an expanded role in the routine and regular assessment of the osteoporosis risk in women with breast cancer. 2 ” All patients initiating AIs need advice regarding exercise, calcium/vitamin D supplements, baseline BMD monitoring (when available), and bone-directed therapy if T-score <2.0 or at least two fracture risk factors were observed. Patients with T-score > 2.0 and no risk factors should be managed based on BMD loss during years 12. Unsatisfactory compliance/decreasing BMD after 1224 months on oral bisphosphonates should trigger a switch to i.v. bisphosphonate. 3

 

2. P. Hadji et al, Management of aromatase inhibitor-associated bone loss in postmenopausal women with breast cancer: practical guidance for prevention and treatment Ann Oncol (2011)
doi: 10.1093/annonc/mdr017, First published online: March 17, 2011

3.Burstein HJ, Temin S, Anderson H, et al: Adjuvant endocrine therapy for women with hormone receptorpositive breast cancer: American Society of Clinical Oncology clinical practice guideline focused update. J Clin Oncol 32:2255-2269, 2014.

GRETCHEN L. JOHNSON, Denosumab (Prolia) for Treatment of Postmenopausal Osteoporosis. Am Fam Physician. 2012 Feb 15;85(4):334-336.

Boonen S, Adachi JD, Cummings SR, et al. Treatment with denosumab reduces the incidence of new vertebral and hip fractures in postmenopausal women at high risk.J Clin Endocrinol Metab2011; 96:1727-36.

Prolia, Prescribing Infomration 2015

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