RESEARCH PAPER
Year : 2019  |  Volume : 10  |  Issue : 4  |  Page : 118-125

Assessment of aromatase inhibitor-induced bone loss and appropriateness of supportive therapy in postmenopausal breast cancer patients at a tertiary care center


1 Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Science Campus, Kochi, Kerala, India
2 Department of Medical Oncology and Hematology, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham, AIMS Health Science Campus, Kochi, Kerala, India

Correspondence Address:
Emmanuel James
Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Science Campus, Kochi - 682 041, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpp.JPP_61_19

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Objective: To assess aromatase inhibitor-induced bone loss (AIBL) and its management in postmenopausal women (PMW) with breast cancer (BC). Materials and Methods: A cohort of 350 PMW with BC receiving aromatase inhibitors (AIs) during a span of 4 years was evaluated retrospectively. Bone mineral density (BMD) of the patients at lumbar spine (LS) and dual femur was monitored at baseline and annually for 2 years. Baseline fracture risk was evaluated using WHO fracture risk assessment tool. Results: At baseline, only 35.4% of the patients received supportive therapy such as calcium and Vitamin D supplements ± bisphosphonates. Significant decrease of mean BMD occurred at LS, left femur, and right femur (LF and RF) at 1 year (P < 0.001) in 64.6% of patients who did not receive supportive therapy at baseline. Those who received supportive therapy at baseline had a significant elevation of their mean BMD at LS, LF, and RF; (P < 0.001) at 1 year, and this increase in BMD persisted at 2 years. Ten-year fracture risk at baseline was 'high' for 3.14% of patients, while 35.43% had 'moderate risk' of major osteoporotic fracture and 26.6% had 'high risk' of hip fracture. Overall incidence of fractures was 1.1% in patients who did not receive supportive therapy from baseline to 1 year. Conclusion: Majority of BC patients on AIs were not prescribed supportive therapy at baseline. Since AI monotherapy caused significant loss of LS and dual femur BMD at 1 year of treatment, up-front supportive therapy should be started concurrently with AIs from baseline for the prevention of AIBL.


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