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Multicenter Study
. 2024 Aug 5;191(2):117-125.
doi: 10.1093/ejendo/lvae086.

Bone-active drugs in premenopausal women with breast cancer under hormone-deprivation therapies

Maria Francesca Birtolo  1   2 , Rebecca Pedersini  3 , Andrea Palermo  4   5 , Walter Vena  1   6 , Emanuela Morenghi  1   7 , Giacomo Cristofolini  1   2 , Barbara Presciuttini  8 , Gaia Tabacco  4 , Anda Mihaela Naciu  4 , Stella Pigni  1   2 , Marta Laganà  3 , Federica Mazzoleni  5 , Deborah Cosentini  3 , Antea Ciafardini  1   2 , Mauro Pagani  8 , Davide Farina  9 , Luca Balzarini  10 , Alberto Zambelli  1   11 , Rosalba Torrisi  11 , Luisella Cianferotti  12 , Nicola Napoli  4   5   13 , Antonio Carlo Bossi  5 , Andrea Gerardo Lania  1   2 , Alfredo Berruti  3 , Gherardo Mazziotti  1   2
Affiliations
Multicenter Study

Bone-active drugs in premenopausal women with breast cancer under hormone-deprivation therapies

Maria Francesca Birtolo et al. Eur J Endocrinol. .

Abstract

Background: Bone health management in premenopausal women with breast cancer (BC) under hormone-deprivation therapies (HDTs) is often challenging, and the effectiveness of bone-active drugs is still unknown.

Methods: This retrospective multicenter study included 306 premenopausal women with early BC undergoing HDTs. Bone mineral density (BMD) and morphometric vertebral fractures (VFs) were assessed 12 months after HDT initiation and then after at least 24 months.

Results: After initial assessment, bone-active drugs were prescribed in 77.5% of women (151 denosumab 60 mg/6 months, 86 bisphosphonates). After 47.0 ± 20.1 months, new VFs were found in 16 women (5.2%). Vertebral fracture risk was significantly associated with obesity (odds ratio [OR] 3.87, P = .028), family history of hip fractures or VFs (OR 3.21, P = .040], chemotherapy-induced menopause (OR 6.48, P < .001), preexisting VFs (OR 25.36, P < .001), baseline T-score less than or equal to -2.5 standard deviation (SD) at any skeletal site (OR 4.14, P = .036), and changes at lumbar and total hip BMD (OR 0.94, P = .038 and OR 0.88, P < .001, respectively). New VFs occurred more frequently in women untreated compared to those treated with bone-active drugs (14/69, 20.8% vs 2/237, 0.8%; P < .001) and the anti-fracture effectiveness remained significant after correction for BMI (OR 0.03; P < .001), family history of fractures (OR 0.03; P < .001), chemotherapy-induced menopause (OR 0.04; P < .001), and preexisting VFs (OR 0.01; P < .001).

Conclusions: Premenopausal women under HDTs are at high risk of VFs in relationship with high BMI, densitometric diagnosis of osteoporosis, preexisting VFs, and family history of osteoporotic fractures. Vertebral fractures in this setting might be effectively prevented by bisphosphonates or denosumab.

Keywords: aromatase inhibitors; bisphosphonates; bone mineral density; breast cancer; denosumab; osteoporosis; premenopausal women; vertebral fractures.

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Conflict of interest statement

Conflict of interest: R.P. received consultancy fees from Roche, Novartis, Eli Lilly, Daiichi Sankyo, Gilead, Eisai, and Accord, outside the submitted work. A.P. reports lecture fees from Amgen, Theramex, and UCB, outside the submitted work. A.N. reports lecture fees from Theramex, outside the submitted work. G.T. reports lectures fees from Theramex and Abiogen, outside the submitted work. R.T. received research grants from Pfizer, consultancy fees from MSD, and lecture fees from Pfizer, Eli Lilly, Eisai, and Genomic Health outside the submitted work. A.Z. received consultancy fees from Roche, Novartis, Pfizer, Eli Lilly & Co., AstraZeneca, and Genomic Health outside the submitted work. L.C. received consultancy fees from UCB and lecture fees from Abiogen Pharma and Bruno Farmaceutici, outside the submitted work. A.C. Bossi reports research grants from Bayer SA, Lilly Italia SpA, MSD USA, and Novo Nordisk Italia SpA and personal fees from Sanofi Italia SpA, Boehringer Ingelheim Italia SpA, and AstraZeneca Italia SpA, outside the submitted work. A.L. received grants from Pfizer and lecture fees from Recordati, outside the submitted work. A.B. reports receiving grants and personal fees from Janssen Cilag, grants and personal fees from Astellas, and personal fees from Bayer outside the submitted work. G.M. received consultancy fees and preceptorship from Amgen–UCB and Sanofi and lectures fees from Theramex and Recordati. The other authors have nothing to declare.

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