"Guidelines for bone health maintenance have been developed," said principal investigator Richard Bell, MD, professor of medical oncology, Andrew Love Cancer Centre, Geelong Hospital, Victoria, Australia. "Practical strategies and algorithms designed to monitor bone health with interventions -- once established and widely implemented -- offer the potential to abrogate this increased fracture risk."

In his presentation on March 22^nd, Dr. Bell noted also that the fracture risks extend to patients with both oestrogen receptor-negative and receptor-positive disease.

Dr. Bell and coinvestigators conducted their study to determine the impact of early breast cancer treatments on the annual risk of fracture. They conducted a calibrated cross-study comparison of the relative risk of fracture across clinical trial populations of postmenopausal women with early breast cancer in various patient groups: healthy women; women who had received treatment for early breast cancer; and women enrolled in the Arimidex or Tamoxifen Alone or in Combination (ATAC) trial.

The investigators matched fracture rates in women with early breast cancer with average population data on healthy postmenopausal women in Australia. The fracture rate in this healthy group was approximately 17 per 1,000 women per year in women who were 69 years old, the average age of women when they completed the ATAC trial.

Results show that early breast cancer -- whether treated early with anastrozole or not -- was associated with an increased risk of fracture. Use of tamoxifen was associated with a reduced risk of fracture, Dr. Bell said.

On the basis of their findings, the researchers extrapolated that, in a clinic treating 300 women with early breast cancer per year, women not receiving hormonal adjuvant therapy would have 1 extra non-hip fracture per year, and those on anastrozole would have 2 extra non-hip fractures, compared with healthy postmenopausal women. Those on tamoxifen would have 1 less non-hip fracture.

"Although caution should be exercised when making cross-study comparisons, this conceptual model demonstrates small benefits for tamoxifen in reducing clinical fractures," he said.

However, he noted that anastrozole is associated with fewer breast cancer recurrences, so concomitant use of a bisphosphonate may be an effective way to prevent recurrence and minimise fracture risk.


[Presentation title: Relative Risk for Fractures in Postmenopausal Women, Postmenopausal Breast Cancer Survivors and Postmenopausal Women Managed With Adjuvant Hormonal Therapy. Abstract 175]

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