Effect of anastrozole on bone mineral density: 5-year results from the anastrozole, tamoxifen, alone or in combination trial 18233230.

2.50
Hdl Handle:
http://hdl.handle.net/10541/68813
Title:
Effect of anastrozole on bone mineral density: 5-year results from the anastrozole, tamoxifen, alone or in combination trial 18233230.
Authors:
Eastell, Richard; Adams, Judith E; Coleman, Robert E; Howell, Anthony ( 0000-0002-3879-5991 ) ; Hannon, Rosemary A; Cuzick, Jack; Mackey, John R; Beckmann, Matthias W; Clack, Glen
Abstract:
PURPOSE: The Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial (median follow-up, 68 months) has shown that adjuvant anastrozole has superior efficacy and better tolerability than tamoxifen. However, anastrozole reduces circulating estrogen, and low estradiol levels are associated with decreased bone mineral density (BMD) and increased fracture risk. It is therefore important to understand the effects of long-term aromatase inhibitor therapy on BMD. PATIENTS AND METHODS: This prospective substudy of the ATAC trial assessed BMD changes in postmenopausal women with invasive primary breast cancer receiving anastrozole (1 mg/d) or tamoxifen (20 mg/d) as adjuvant therapy for 5 years. Lumbar spine and total hip BMD were assessed at baseline and after 1, 2, and 5 years. RESULTS: One hundred ninety-seven women from the monotherapy arms of the ATAC trial were recruited onto the bone substudy, and 108 were included in the primary analysis. Among anastrozole-treated patients, there was a decrease in median BMD from baseline to 5 years in lumbar spine (-6.08%) and total hip (-7.24%) compared with the tamoxifen group (lumbar spine, +2.77%; total hip, +0.74%). No patients with normal BMD at baseline became osteoporotic at 5 years. CONCLUSION: Anastrozole is associated with accelerated bone loss over the 5-year treatment period. However, although patients with pre-existing osteopenia are likely to require monitoring and bone-protection strategies, patients with normal BMD would not appear to require monitoring beyond the recommendation for healthy postmenopausal women. The effect of anastrozole on bone should be weighed against its superior efficacy and better tolerability profile versus tamoxifen in the main ATAC trial.
Affiliation:
Academic Unit of Bone Metabolism, University of Sheffield, UK. r.eastell@sheffield.ac.uk
Citation:
Effect of anastrozole on bone mineral density: 5-year results from the anastrozole, tamoxifen, alone or in combination trial 18233230. 2008, 26 (7):1051-7 J. Clin. Oncol.
Journal:
Journal of Clinical Oncology
Issue Date:
1-Mar-2008
URI:
http://hdl.handle.net/10541/68813
DOI:
10.1200/JCO.2007.11.0726
PubMed ID:
18309940
Type:
Article
Language:
en
ISSN:
1527-7755
Appears in Collections:
All Christie Publications ; Medical Oncology

Full metadata record

DC FieldValue Language
dc.contributor.authorEastell, Richard-
dc.contributor.authorAdams, Judith E-
dc.contributor.authorColeman, Robert E-
dc.contributor.authorHowell, Anthony-
dc.contributor.authorHannon, Rosemary A-
dc.contributor.authorCuzick, Jack-
dc.contributor.authorMackey, John R-
dc.contributor.authorBeckmann, Matthias W-
dc.contributor.authorClack, Glen-
dc.date.accessioned2009-05-22T14:09:34Z-
dc.date.available2009-05-22T14:09:34Z-
dc.date.issued2008-03-01-
dc.identifier.citationEffect of anastrozole on bone mineral density: 5-year results from the anastrozole, tamoxifen, alone or in combination trial 18233230. 2008, 26 (7):1051-7 J. Clin. Oncol.en
dc.identifier.issn1527-7755-
dc.identifier.pmid18309940-
dc.identifier.doi10.1200/JCO.2007.11.0726-
dc.identifier.urihttp://hdl.handle.net/10541/68813-
dc.description.abstractPURPOSE: The Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial (median follow-up, 68 months) has shown that adjuvant anastrozole has superior efficacy and better tolerability than tamoxifen. However, anastrozole reduces circulating estrogen, and low estradiol levels are associated with decreased bone mineral density (BMD) and increased fracture risk. It is therefore important to understand the effects of long-term aromatase inhibitor therapy on BMD. PATIENTS AND METHODS: This prospective substudy of the ATAC trial assessed BMD changes in postmenopausal women with invasive primary breast cancer receiving anastrozole (1 mg/d) or tamoxifen (20 mg/d) as adjuvant therapy for 5 years. Lumbar spine and total hip BMD were assessed at baseline and after 1, 2, and 5 years. RESULTS: One hundred ninety-seven women from the monotherapy arms of the ATAC trial were recruited onto the bone substudy, and 108 were included in the primary analysis. Among anastrozole-treated patients, there was a decrease in median BMD from baseline to 5 years in lumbar spine (-6.08%) and total hip (-7.24%) compared with the tamoxifen group (lumbar spine, +2.77%; total hip, +0.74%). No patients with normal BMD at baseline became osteoporotic at 5 years. CONCLUSION: Anastrozole is associated with accelerated bone loss over the 5-year treatment period. However, although patients with pre-existing osteopenia are likely to require monitoring and bone-protection strategies, patients with normal BMD would not appear to require monitoring beyond the recommendation for healthy postmenopausal women. The effect of anastrozole on bone should be weighed against its superior efficacy and better tolerability profile versus tamoxifen in the main ATAC trial.en
dc.language.isoenen
dc.subjectBreast Canceren
dc.subjectCancer Invasivenessen
dc.subject.meshAntineoplastic Combined Chemotherapy Protocols-
dc.subject.meshBone Density-
dc.subject.meshBreast Neoplasms-
dc.subject.meshCase-Control Studies-
dc.subject.meshChemotherapy, Adjuvant-
dc.subject.meshFemale-
dc.subject.meshHumans-
dc.subject.meshNeoplasm Invasiveness-
dc.subject.meshNitriles-
dc.subject.meshPostmenopause-
dc.subject.meshProspective Studies-
dc.subject.meshTamoxifen-
dc.subject.meshTreatment Outcome-
dc.subject.meshTriazoles-
dc.titleEffect of anastrozole on bone mineral density: 5-year results from the anastrozole, tamoxifen, alone or in combination trial 18233230.en
dc.typeArticleen
dc.contributor.departmentAcademic Unit of Bone Metabolism, University of Sheffield, UK. r.eastell@sheffield.ac.uken
dc.identifier.journalJournal of Clinical Oncologyen
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