Your Guide To Doctors, Health Information, and Better Health!
Your Health Magazine Logo
The following article was published in Your Health Magazine. Our mission is to empower people to live healthier.
Isabella Martire, MD, Board Certified In Oncology
Bone Protective Therapy in Breast Cancer Patients
Isabella C. Martire, MD, AC
. https://www.isabellamartire-md.com/

Bone Protective Therapy in Breast Cancer Patients

Bone health is very important for breast cancer patients because pre-menopausal women who get chemotherapy in the adjuvant setting will have ovarian failure almost 90% of the time, which will lead to osteopenia and bone loss. Post-menopausal women ER/PR positive often time will have as part of standard care aromatase inhibitors, which are also associated with bone loss and osteoporosis increase in the risk for fractures.

Also, pre-menopausal patients may be receiving hormonal therapy coupled with GNRH (gonadotropin releasing hormone), which causes chemical suppression of the ovaries and are at increased risk of osteopenia/osteoporosis.

Nowadays, several drugs have been FDA approved to prevent or reverse bone loss. The initial oral bisphosphonates, which were FDA-approved, were not very popular because of frequent gastrointestinal problems.

Intravenous zolendronic acid (Reclast) was better tolerated but in ~2% of cases could cause osteonecrosis of the jaw in particular if dental trauma occurs or if patients have poor oral hygiene. Reclast is an intravenous bisphosphonate given once a year. The infusion is less than one hour. It inhibits osteoclastic bone resorption. The calcium level needs to be checked prior to treatment and if low, calcium and vitamin D to be supplemented.

Prolia (denosumab) could cause an allergic reaction. It reduced the risk of fracture 66% compared to placebo. The rank ligand inhibitor (denosumab) a subcutaneous injection given every six months revealed increased bone mineral density and decrease in bone fracture. Calcium and vitamin D are given as supplements.

It appears that bisphosphonate therapy has an antitumor effect as well, increasing disease-free survival and overall survival in post-menopausal women while reducing the incidence of fractures.

In patients with metastatic disease to the bones, zolendronic acid (Zometa) is given monthly at a dose of 4mg and denosumab (Xgeva) is also given monthly at a dose of 120mg. All bone protective agents have greatly decreased the incidence of fractures.

MD (301) 805-6805 | VA (703) 288-3130