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Breast Cancer and Bone Loss

Posted Jan 26 2010 12:00am
A new report in the British Journal of Cancer assessed fracture risk in breast cancer patients based on current guidelines for treatment with bisphosphonates to protect bone health.  This study compared this assessment with emerging international guidelines. 

Current Guidelines:  These state that bisphosphonates are appropriate for "patients with plain radiographic evidence of bone destruction", which means patients with osteoporosis defined as a bone mineral density score of less than -2.5.

Emerging International Guidelines:  Any patient receiving therapy with aromatase inhibitors with any two of the following risk factors are recommended to receive bisphosphonate treatment:  T-score <–1.5, age >65 years, low BMI (<20), family history of hip fracture, personal history of fragility fracture after age 50, oral corticosteroid use >6 months, and smoking.

The results of this comparison showed:
  • Low bone mineral density was more common in postmenopausal women than in premenopausal women.
  • Postmenopausal women with estrogen receptor - positive (ER+) breast cancer had a higher rate of poor bone health compared to postmenopausal women with estrogen receptor - negative breast cancer.
  • Based on current guidelines, only 9% of the breast cancer patients studied would have been eligible for bisphosphonate treatment.
  • Based on the emerging international guidelines, 28% of the breast cancer patients would have been eligible for treatment with bisphosphonates for bone health.
  • The authors estimated that current guidelines would prevent only 18% of possible fractures, while the emerging guidelines would prevent about 45% of possible fractures.
While the incidence of poor bone health in ER+ breast cancer patients, particularly postmenopausal patients, is not surprising, the difference between the current guidelines for bisphosphonate treatment and the emerging guidelines are rather astonishing.  The emerging guidelines would substantially increase the number of breast cancer patients eligible for bisphosphonate treatment and might substantially decrease the occurrence of bone fractures.  Should these emerging guidelines become part of the standard of care for breast cancer patients, we might see an improvement in the overall quality of life for breast cancer survivors.

Become proactive and fight against breast cancer now.  To find out many simple steps you can take to reduce your breast cancer risk, read my book Fight Now: Eat & Live Proactively Against Breast Cancer at
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