Groups Issue Joint Statement on Aromatase Inhibitors and Bone Loss

LISA SCHULMEISTER, RN, MN, APRN-BC, FAAN
Monday, May 01, 2017
Talk about this article with nurses and others in the oncology community in the General Discussions Oncology Nursing News discussion group.
Seven professional organizations have jointly collaborated to issue a new position statement that provides recommendations on the treatment of aromatase inhibitor (AI)–related bone loss (AIBL) in postmenopausal women receiving treatment for hormone-sensitive breast cancer. The statement also is applicable to other postmenopausal women not being considered for an AI treatment and those receiving ovarian suppression therapies.

A systematic literature review was conducted, and relevant trials and studies are reviewed in the article and assigned a level of evidence. Individual AI agents were assessed based on trial design, size, follow-up, and safety. Several fracture-related risk factors (RF) in patients with early breast cancer were identified.

Overall, the evidence for fracture prevention is strongest for denosumab 60 mg every 6 months. Studies support additional anticancer benefits from adjuvant bisphosphonate treatment in postmenopausal women with a 34% relative risk reduction in bone metastasis and 17% relative risk decrease in breast cancer mortality.

In all patients initiating AI treatment, fracture risk should be assessed. Exercise, such as resistance and weight-bearing exercise, and (minimally) calcium 1200 mg daily and vitamin D 800 to 1000 IU daily should be recommended.

Bone-directed therapy should be given to all patients with a T-score <−2.0 or with a T-score of <–1.5 SD with 1 additional RF, or with ≥2 risk factors (without bone mineral density [BMD]) for the duration of AI treatment. Patients with T-score >−1.5 SD and no risk factors should be managed based on BMD loss during the first year and the local guidelines for postmenopausal osteoporosis. Adherence should be regularly assessed. Because of the decreased incidence of bone recurrence and breast cancer specific mortality, adjuvant bisphosphonates are recommended for all postmenopausal women at significant risk of disease recurrence. The position statement is available here.

Talk about this article with nurses and others in the oncology community in the General Discussions Oncology Nursing News discussion group.
Lisa Schulmeister, MN, RN, ACNS-BC, FAAN
 
Blog Info
Lisa Schulmeister, MN, RN, ACNS-BC, FAAN is an oncology nursing consultant and editor-in-chief of Oncology Nursing News.
Author Bio
Lisa Schulmeister, MN, RN, ACNS-BC, FAAN, is the Editor-in-Chief for OncLive Nursing. She is an oncology nursing consultant and adjunct assistant professor of nursing at Louisiana State Health Sciences Center in New Orleans, LA. She provides continuing nursing education to nurses across the Unites States, is active in several professional nursing organizations, and is intrigued by the many ways nurses use technology to communicate.
 
 
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