Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/20720
Title: The effects of adjuvant endocrine therapy on bone health in women with breast cancer.
Authors: Ramchand, Sabashini K;Cheung, Yee-Ming;Yeo, Belinda;Grossmann, Mathis
Affiliation: Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
Department of Oncology, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Issue Date: 1-Apr-2019
EDate: 2019-04-01
Citation: The Journal of endocrinology 2019; online first: 1 April
Abstract: In women with oestrogen-receptor (ER) positive early breast cancer, oestradiol is important for breast cancer development and progression. Endocrine therapy prevents the deleterious effects of oestradiol in breast tissue by systemically depleting oestradiol concentration (aromatase inhibitors) or preventing its local action in breast tissue (selective oestrogen receptor modulators i.e. tamoxifen), thereby improving oncological outcomes. Use of aromatase inhibitors in postmenopausal women and ovarian function suppression with either tamoxifen or aromatase inhibition in premenopausal women, consequent to systemic oestradiol depletion, exerts detrimental effects on skeletal health. The oestradiol deficient state causes increased bone remodelling and a negative bone balance. This results in bone loss, microstructural deterioration and bone fragility predisposing to fractures. Similar effects are also seen with tamoxifen in premenopausal women. In contrast, use of tamoxifen in postmenopausal women appears to exert protective effects on bone but studies on fracture risk are inconclusive. The longevity of women with ER positive breast cancer treated with adjuvant endocrine therapy emphasises the need to mitigate the adverse skeletal effects of these therapies in order to maximise benefit. In general, fractures are associated with increased morbidity, mortality and are a high socio-economic burden. Whilst the efficacy of antiresorptive therapy in preventing bone mineral density loss in postmenopausal women has been established, further clinical trial evidence is required to provide guidance regarding fracture risk reduction, when to initiate and stop treatment, choice of agent and optimal management of bone health in premenopausal women receiving endocrine therapy. In addition, potential oncological benefits of antiresorptive therapies will also need to be considered.
URI: http://ahro.austin.org.au/austinjspui/handle/1/20720
DOI: 10.1530/JOE-19-0077
ORCID: 0000-0002-9218-9917
0000-0001-8261-3457
PubMed URL: 30991355
Type: Journal Article
Review
Appears in Collections:Journal articles

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