Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO, IMS, and SIOG

• Published in: Journal of bone oncology 2017-06, Vol.7 (C), p.1-12
• Main Authors: Hadji, Peyman, Aapro, Matti S., Body, Jean-Jacques, Gnant, Michael, Brandi, Maria Luisa, Reginster, Jean Yves, Zillikens, M. Carola, Glüer, Claus-C., de Villiers, Tobie, Baber, Rod, Roodman, G. David, Cooper, Cyrus, Langdahl, Bente, Palacios, Santiago, Kanis, John, Al-Daghri, Nasser, Nogues, Xavier, Eriksen, Erik Fink, Kurth, Andreas, Rizzoli, Rene, Coleman, Robert E.
• Format: Article
• Language: English
• Subjects: Bisphosphonate; Breast cancer; Denosumab; Endocrine treatment; Fracture; General & internal medicine; Human health sciences; Médecine générale & interne; Osteoporosis; Review; Sciences de la santé humaine
• ISSN: 2212-1374; 2212-1366; 2212-1374
• DOI: 10.1016/j.jbo.2017.03.001

Several guidelines have been reported for bone-directed treatment in women with early breast cancer (EBC) for averting fractures, particularly during aromatase inhibitor (AI) therapy. Recently, a number of studies on additional fracture related risk factors, new treatment options as well as real world studies demonstrating a much higher fracture rate than suggested by randomized clinical controlled trials (RCTs). Therefore, this updated algorithm was developed to better assess fracture risk and direct treatment as a position statement of several interdisciplinary cancer and bone societies involved in the management of AI-associated bone loss (AIBL). A systematic literature review identified recent advances in the management of AIBL. Results with individual agents were assessed based on trial design, size, follow-up, and safety. Several fracture related risk factors in patients with EBC were identified. Although, the FRAX algorithm includes fracture risk factors (RF) in addition to BMD, it does not seem to adequately address the effects of AIBL. Several antiresorptive agents can prevent and treat AIBL. However, concerns regarding compliance and long-term safety remain. Overall, the evidence for fracture prevention is strongest for denosumab 60mgs.c. every 6 months. Additionally, recent studies as well as an individual patient data meta-analysis of all available randomized trial data 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 that needs to be taken into account when advising on management of AIBL. In all patients initiating AI treatment, fracture risk should be assessed and recommendation with regard to exercise and calcium/vitamin D supplementation given. Bone-directed therapy should be given to all patients with a T-score