Breast cancer therapy and bone

Abstract

Breast cancer is the most common cancer in women and the leading cause of cancer-associated mortality. The estrogen deprivation associated with therapies used to treat this disease may result in significant loss of bone density and a consequent increase in fracture risk. Anti-resorptive osteoporosis therapies (bisphosphonates and the inhibitor of receptor activator of nuclear factor-κB ligand [RANKL] denosumab) play an important role in the mitigation of cancer therapy-induced bone loss (CTIBL), and may function as adjuvant therapy in moderate to high-risk breast cancer to prevent disease recurrence. Various international guidelines have delineated treatment thresholds based on both bone density assessment and clinical risk factors for CTIBL. The role of these bone-targeted therapies as adjuvant anti-cancer treatment is evolving. Currently, evidence supports the use of the bisphosphonates, zoledronic acid and clodronate, in this setting. Unfortunately, a focus on bone health in women with breast cancer is often not prioritized, leaving this group vulnerable to significant bone loss and subsequent fracture.

乳腺癌治疗与骨 摘要

乳腺癌是女性最常见的癌症, 也是癌症相关死亡的主要原因。与治疗这种疾病相关的雌激素缺乏可能会导致骨密度的显著下降, 从而增加骨折的风险。抗吸收性骨质疏松症治疗（双膦酸盐和核因子κB受体激活剂抑制剂配体[RANKL]地诺单抗）在减轻癌症治疗引起的骨丢失（CTIBL）方面发挥着重要作用, 可作为中高危乳腺癌的辅助治疗以防止疾病复发。各种国际指南都根据骨密度评估和CTIBL的临床危险因素划定了治疗阈值。这些骨靶向疗法作为辅助抗癌治疗的作用正在演变。目前, 有证据支持在这种情况下应用双膦酸盐、唑来膦酸和氯膦酸盐。不幸的是, 对乳腺癌女性的骨骼健康的关注往往没有得到优先考虑, 这使得这一群体容易受到严重的骨流失和随后的骨折。

Keywords:

• Breast cancer
• osteoporosis
• aromatase inhibitor
• bone loss
• bisphosphonates
• denosumab

Potential conflict of interest

The authors report no conflict of interest. The authors alone are responsible for the content and writing of the article.

Source of funding

Nil.