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Title: Assessment and management of bone health in women with oestrogen receptor-positive breast cancer receiving endocrine therapy: Position statement of the Endocrine Society of Australia, the Australian and New Zealand Bone & Mineral Society, the Australasian Menopause Society and the Clinical Oncology Society of Australia.
Austin Authors: Grossmann, Mathis ;Ramchand, Sabashini K ;Milat, Frances;Vincent, Amanda;Lim, Elgene;Kotowicz, Mark A;Hicks, Jill;Teede, Helena
Affiliation: Endocrinology
Medicine (University of Melbourne)
Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
Hudson Institute of Medical Research, Clayton, Victoria, Australia
Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
Monash Centre for Health Research and Implementation, Monash Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
St Vincent's Hospital, University of New South Wales Sydney, Darlinghurst, NSW, Australia
Deakin University, Geelong, Victoria, Australia
Department of Endocrinology and Diabetes, University Hospital, Geelong, Victoria, Australia
Department of Medicine, Melbourne Medical School - Western Campus, The University of Melbourne, St Albans, Victoria, Australia
Breast Cancer Network Australia, Camberwell, Victoria, Australia
Issue Date: 9-May-2018
Date: 2018-05-09
Publication information: Clinical Endocrinology 2018; 89(3): 280-296
Abstract: To formulate clinical consensus recommendations on bone health assessment and management of women with oestrogen receptor-positive early breast cancer receiving endocrine therapy, representatives appointed by relevant Australian Medical Societies used a systematic approach for adaptation of guidelines (ADAPTE) to derive an evidence-informed position statement addressing 5 key questions. Women receiving adjuvant aromatase inhibitors and the subset of premenopausal woman treated with tamoxifen have accelerated bone loss and increased fracture risk. Both bisphosphonates and denosumab prevent bone loss; additionally, denosumab has proven antifracture benefit. Women considering endocrine therapy need fracture risk assessment, including clinical risk factors, biochemistry and bone mineral density (BMD) measurement, with monitoring based on risk factors. Weight-bearing exercise, vitamin D and calcium sufficiency are recommended routinely. Antiresorptive treatment should be considered in women with prevalent or incident clinical or morphometric fractures, a T-score (or Z-scores in women <50 years) of <-2.0 at any site, or if annual bone loss is ≥5%, considering baseline BMD and other fracture risk factors. Duration of antiresorptive treatment can be individualized based on absolute fracture risk. Relative to their skeletal benefits, risks of adverse events with antiresorptive treatments are low. Skeletal health should be considered in the decision-making process regarding choice and duration of endocrine therapy. Before and during endocrine therapy, skeletal health should be assessed regularly, optimized by nonpharmacological intervention and where indicated antiresorptive treatment, in an individualized, multidisciplinary approach. Clinical trials are needed to better delineate long-term fracture risks of adjuvant endocrine therapy and to determine the efficacy of interventions designed to minimize these risks.
DOI: 10.1111/cen.13735
ORCID: 0000-0001-8261-3457
Journal: Clinical Endocrinology
PubMed URL: 29741296
Type: Journal Article
Subjects: bone density
early Breast cancer
oestradiol deprivation
Appears in Collections:Journal articles

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