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 withany two of the following risk factors are recommended to receive bisphosphonate treatment: T-score <–1.5,age >65 yearslow BMI (<20)family history ofhip fracturepersonal history of fragility fracture after age50oral corticosteroid use >6 monthsand 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 guidelinesonly 9% of the breast cancer patients studied would have been eligible for bisphosphonate treatment.
Based on the emerging international guidelines28% 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 fractureswhile the emerging guidelines would prevent about 45% of possible fractures.
While the incidence of poor bone health in ER+ breast cancer patientsparticularly postmenopausal patientsis not surprisingthe 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 patientswe might see an improvement in the overall quality of life for breast cancer survivors.
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