Increased Fracture Risk in Women Treated With Aromatase Inhibitors Versus Tamoxifen: Beneficial Effect of Bisphosphonates
| Autor: | Marta Pineda-Moncusí, Sonia Servitja, Adolfo Diez-Perez, Natalia Garcia-Giralt, Xavier Nogués, Ignasi Tusquets, Daniel Prieto-Alhambra |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Oncology medicine.medical_specialty medicine.drug_class Estrogems and serms Endocrinology Diabetes and Metabolism medicine.medical_treatment Osteoporosis 030209 endocrinology & metabolism Breast Neoplasms 03 medical and health sciences Fractures Bone 0302 clinical medicine Breast cancer Risk Factors Fracture prevention Internal medicine General population studies medicine Humans Orthopedics and Sports Medicine Aromatase Aromatase inhibitor biology Diphosphonates Proportional hazards model business.industry Aromatase Inhibitors Hazard ratio Fracture risk assessment Bisphosphonate medicine.disease Tamoxifen 030104 developmental biology biology.protein Female business medicine.drug |
| Zdroj: | Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral ResearchReferences. 35(2) |
| ISSN: | 1523-4681 |
| Popis: | Aromatase inhibitors have been associated with accelerated bone loss and an increased risk of osteoporotic fractures. Currently, bisphosphonates are recommended to reduce fracture risk in these patients. The aim of this study is to evaluate the fracture risk in breast cancer patients receiving aromatase inhibitors, compared to tamoxifen users, and to assess the effectiveness of oral bisphosphonates in reducing fracture risk. We performed an observational cohort study up to 10 years of follow-up. Data were extracted from primary care records in a population database. Women diagnosed with breast cancer between 2006 and 2015 and treated with tamoxifen or aromatase inhibitors (n = 36,472) were stratified according to low (without osteoporosis diagnosis nor bisphosphonates exposure) or high (with osteoporosis and/or treated with bisphosphonates) fracture risk. Cox models were used to calculate hazard ratios (HR [95% CI]) of fracture from the propensity score-matched patients. Sensitivity analyses account for competing risk of death were performed (subdistribution hazard ratio [SHR] [95% CI]). In postmenopausal women, fracture risk in aromatase inhibitor users showed an HR 1.40 [95% CI,1.05 to 1.87] and SHR 1.48 [95% CI, 1.11 to 1.98], compared to tamoxifen. Observing aromatase inhibitors patients at high risk of fracture, bisphosphonate-treated patients had an HR 0.73 [95% CI, 0.51 to 1.04] and SHR 0.69 [95% CI, 0.48 to 0.98] compared to nontreated. In conclusion, fracture risk in postmenopausal women during aromatase inhibitor treatment, in real-life conditions, was >40% compared to tamoxifen, corroborating previous randomized controlled trials results. In high-risk patients, bisphosphonate users had lower significant fracture incidence during aromatase inhibitor therapy than nonbisphosphonate users. Monitoring fracture risk and related risk factors in aromatase inhibitor patients is advisable. © 2019 American Society for Bone and Mineral Research. |
| Databáze: | OpenAIRE |
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