The role of bone modifying agents for secondary osteoporosis prevention and pain control in post-menopausal osteopenic breast cancer patients undergoing adjuvant aromatase inhibitors.

Autor:	Galvano A; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy., Gristina V; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy., Scaturro D; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy., Bazan Russo TD; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy., Tomasello S; Neuromotor and Cognitive Rehabilitation Research Center, Physical and Rehabilitation Medicine Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy., Vitagliani F; Department of Biomedical Sciences (BIOMED), University of Catania, Catania, Italy., Carità F; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy., La Mantia M; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy., Fulfaro F; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy., Bazan V; Department of Biomedicine, Neuroscience and Advanced Diagnostics - BIND, University of Palermo, Palermo, Italy., Mauro GL; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy., Russo A; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
Jazyk:	angličtina
Zdroj:	Frontiers in endocrinology [Front Endocrinol (Lausanne)] 2023 Nov 21; Vol. 14, pp. 1297950. Date of Electronic Publication: 2023 Nov 21 (Print Publication: 2023).
DOI:	10.3389/fendo.2023.1297950
Abstrakt:	Introduction: Hormonal therapy (HT) blocks the hormone-mediated growth signal dramatically reducing estrogenic levels with aromatase inhibitors (AIs) becoming a crucial component of the treatment mainstay in patients with early breast cancer (BC). Postmenopausal BC patients receiving HT present with a significant risk of secondary osteoporosis with AIs further reducing estrogen levels and ultimately leading to an accelerated rate of bone resorption and thus decreased bone mineral density (BMD). This was an observational retrospective clinical study that consecutively enrolled early BC patients with osteopenia to compare the impact of alendronate versus denosumab on secondary osteoporosis prevention and pain control. Methods: We identified two groups of patients treated with denosumab 60 mg by subcutaneous injection once every six months or alendronate 70 mg orally once a week. All the patients underwent a baseline physiatric evaluation (T0) and underwent a follow-up visit after 18 months (T1) together with femoral and vertebral Dual-Energy X-ray Absorptiometry (DEXA) exam evaluating T-Score marks. From September 2015 to December 2019 a total of 50 early (stage I-III) BC patients were considered eligible and consecutively enrolled in our study if they met pre-specified inclusion criteria. Results: In the entire observed population, the addition of treatment with alendronate or denosumab led to a significant T-score improvement at the lumbar spine level (-1.92 vs -1.52, p=0.03), with a comparable contribution from alendronate (-1.60 vs -1.45, p=0.07) and denosumab (-2.26 vs -1.58, p=0.07). Regarding the femoral region, neither alendronate (-0.98 vs -1.07, p=0.23) nor denosumab (-1.39 vs -1.34, p=0.81) were able to produce any statistically relevant effect. However, concerning pain control, BMAs had a significant impact on reducing NRS scoresin the general population (T1 3.94 vs. baseline 4.32, p=0.007), with a likelyspecific contribution from alendronate (T1 3.52 vs. baseline 3.88, p=0.004) compared to denosumab (T1 4.36 vs baseline 4.76, p=0.12), without any differences in analgesic therapy assumption over time (p=0.93). Discussion: Both alendronate and denosumab significantly contributed to preventing secondary osteoporosis in early BC patients with low BMD undergoing AIs, mostly at the lumbar spine level. Moreover, alendronate seemed to significantly impact pain control in such patients further supporting alendronate as a cost-effective option in this frail setting, although BMAs particularities should be carefully considered on an individual basis according to specific clinical contexts. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2023 Galvano, Gristina, Scaturro, Bazan Russo, Tomasello, Vitagliani, Carità, La Mantia, Fulfaro, Bazan, Mauro and Russo.)
Databáze:	MEDLINE
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