Bone health in women with early-stage breast cancer

Bone health is an increasingly important concern in breast cancer survivors because in postmenopausal women, bone-sparing tamoxifen is being replaced by aromatase inhibitors, whereas in premenopausal women, ovarian suppression is playing an increasing role in adjuvant management. Estrogen reduction resulting from aromatase inhibition and ovarian suppression are associated with loss in bone mineral density (BMD) and an increase in fracture risk. These side effects must be placed in context of the overall risks and benefits seen with these interventions. The American Society of Clinical Oncology has outlined a management strategy for bone health maintenance in breast cancer survivors with early-stage disease that incorporates baseline and ongoing screening for BMD and treatment based on BMD results. Limited but consistent data suggest bisphosphonate therapy represents a treatment option for this condition. A variety of interventions to maintain bone health in breast cancer survivors are undergoing clinical evaluation and include the oral bisphosphonates risedronate and clodronate, the intravenous bisphosphonate zoledronic acid, the receptor activator of nuclear factor-kB ligand inhibitor AMG-162, and the hormonal agent tibolone. Current information suggests bone loss associated with estrogen reduction in breast cancer survivors may represent a preventable and treatable condition. Ongoing clinical trials will definitively evaluate this hypothesis.