Off-treatment bone mineral density changes in postmenopausal women receiving anastrozole for 5 years: 7-year results from the IBIS-II prevention trial

• Published in: British journal of cancer 2021-04, Vol.124 (8), p.1373-1378
• Main Authors: Sestak, Ivana, Blake, Glen, Patel, Raj, Cuzick, Jack, Howell, Anthony, Coleman, Robert, Eastell, Richard
• Format: Article
• Language: English
• Subjects: 692/308/2779/777; 692/699/67/1347; Absorptiometry, Photon; Aged; Anastrozole; Anastrozole - administration & dosage; Anastrozole - adverse effects; Aromatase Inhibitors - administration & dosage; Aromatase Inhibitors - adverse effects; Biomedical and Life Sciences; Biomedicine; Bisphosphonates; Bone density; Bone Density - drug effects; Bone mineral density; Breast cancer; Breast Neoplasms - prevention & control; Cancer Research; Case-Control Studies; Double-Blind Method; Drug Resistance; Dual energy X-ray absorptiometry; Epidemiology; Female; Femur Neck - diagnostic imaging; Femur Neck - drug effects; Hip; Humans; Middle Aged; Molecular Medicine; Oncology; Placebos; Post-menopause; Postmenopause; Risedronic acid; Spine (lumbar); Spine - diagnostic imaging; Spine - drug effects
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/s41416-020-01228-2

Background Anastrozole has been associated with substantial accelerated bone mineral density (BMD) loss during active treatment. Methods One thousand four hundred and ten women were included in a BMD substudy and stratified into three strata according to their baseline T-score at spine or femoral neck. The primary objective of this analysis was to investigate whether DXA BMD at the spine and hip changed two years after treatment cessation (between years 5 and 7) in those who did not receive risedronate. Results Five- and seven-year BMD data were available for a total of 528 women who did not receive risedronate. In women with normal BMD at baseline, an increase in BMD at the lumbar spine after anastrozole withdrawal was observed 1.25% (95% CI 0.73 to 1.77) ( P  = 0.0004), which was larger than in those on placebo (0.14% (−0.29 to 0.56))). At the hip, BMD remained unchanged between years 5 and 7 for those previously on anastrozole but continued to a decrease in those who had been randomised to placebo (−1.35% (−1.70 to −0.98)). Conclusions These are the first results reporting BMD changes after stopping anastrozole in a breast cancer prevention setting. Our results show that the negative effects of anastrozole on BMD in the preventive setting are partially reversible.