Systematic Review of Bone Health in Older Women Treated with Aromatase Inhibitors for Early-Stage Breast Cancer

Authors

  • Taryn Becker MD, MSc, FRCPC,

    Corresponding author
    1. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    2. Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
    • Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Lorraine Lipscombe MD, MSc, FRCPC,

    1. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    2. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    3. Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
    4. Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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  • Steven Narod MD, MSc, FRCPC,

    1. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    2. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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  • Christine Simmons MD, MSc, FRCPC,

    1. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    2. St. Michael's Hospital, Toronto, Ontario, Canada
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  • Geoffrey M. Anderson MD, PhD,

    1. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    2. Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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  • Paula A. Rochon MD, MPH, FRCPC

    1. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    2. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    3. Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
    4. Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Address correspondence to Dr. Taryn Becker, Women's College Research Institute, Room 734, 790 Bay Street, Toronto, Ontario M5G 1N8, Canada. E-mail: taryn.becker@wchospital.ca

Abstract

Objectives

To review data from randomized controlled trials (RCTs) that evaluate adverse bone outcomes in older women using aromatase inhibitors (AIs) for early-stage hormone receptor–positive breast cancer.

Design

Systematic review.

Setting

International RCTs referenced in Medline and EMBASE databases through August 1, 2011.

Participants

Postmenopausal women with early-stage hormone receptor–positive breast cancer receiving adjuvant endocrine therapy.

Measurements

Fracture rates and changes in bone turnover markers and bone mineral density.

Results

Eleven RCTs were identified. The majority of trials included women with a mean age in the 60s; and women aged 75 and older and 80 and older were excluded from two studies. Fracture rates ranged from 0.9% to 11%, with AIs having a 1.5 times higher risk than tamoxifen or placebo. Fracture data were not systematically collected in many of these trials. In a small subpopulation of women, AIs were associated with higher markers of bone turnover and lower bone density. The relationship between age and fracture was not described.

Conclusion

AIs are associated with low bone density and high fracture risk in women with a mean age in their early 60s. There is a paucity of data describing the effect of baseline fracture risk factors, particularly age, and the longer-term effects on bone health in older women. Future research is needed regarding baseline fracture risk, interventions, and long-term effects on bone in this vulnerable population to inform management decisions to optimize AI duration and ensure quality of life after breast cancer.

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