Breast cancer outcome in relation to bone mineral density and bisphosphonate use: a sub-study of the DATA trial

• Published in: Breast cancer research and treatment Vol. 180; no. 3; pp. 675 - 685
• Main Authors: van Hellemond, Irene E. G., Smorenburg, Carolien H., Peer, Petronella G. M., Swinkels, Astrid C. P., Seynaeve, Caroline M., van der Sangen, Maurice J. C., Kroep, Judith R., de Graaf, Hiltje, Honkoop, Aafke H., Erdkamp, Frans L. G., van den Berkmortel, Franchette W. P. J., de Roos, Wilfred K., Linn, Sabine C., Imholz, Alexander L. T., de Boer, Maaike, Tjan-Heijnen, Vivianne C. G.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2020; Springer; Springer Nature B.V
• Subjects: Anastrozole; Antineoplastic Agents, Hormonal - adverse effects; Bisphosphonates; Bone density; Bone Density - drug effects; Bone Density Conservation Agents - therapeutic use; Bone Diseases, Metabolic - chemically induced; Bone Diseases, Metabolic - drug therapy; Bone Diseases, Metabolic - mortality; Bone Diseases, Metabolic - pathology; Bone mineral density; Bones; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - pathology; Cancer; Cancer patients; Cancer research; Carcinoma, Lobular - drug therapy; Carcinoma, Lobular - pathology; Clinical Trial; Comparative analysis; Density; Diphosphonates - therapeutic use; Dual energy X-ray absorptiometry; Female; Follow-Up Studies; Health risk assessment; Humans; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - pathology; Oncology; Oncology, Experimental; Osteopenia; Osteoporosis; Osteoporosis - chemically induced; Osteoporosis - drug therapy; Osteoporosis - mortality; Osteoporosis - pathology; Patient outcomes; Phosphonates; Post-menopause; Postmenopausal women; Prognosis; Survival Rate; Tamoxifen; Tamoxifen - adverse effects; Bone health; Osteoporosis; Aromatase inhibitor; Distant recurrence-free survival; Breast cancer; Tamoxifen; Bisphosphonates; Survival; Bone metastases
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-020-05567-9

Purpose The phase III DATA study compared 6 and 3 years of adjuvant anastrozole following 2–3 years of tamoxifen in postmenopausal breast cancer patients. This pre-planned side-study assessed the relationship between a reduced bone mineral density (BMD) and distant recurrence-free survival (DRFS), and evaluated the effect of bisphosphonates on DRFS. Methods We selected all patients with a BMD measurement within 3 years after randomisation (landmark) without any DRFS events. Kaplan–Meier methods and Cox proportional hazards models were used for analyses. Results Of 1860 eligible patients, 1142 had a DEXA scan before the landmark. The BMD was normal in 436 (38.2%) and showed osteopenia in 565 (49.5%) and osteoporosis in 141 (12.3%) patients. After a median follow-up of 5.0 years from the landmark, neither osteopenia nor osteoporosis (compared with normal BMD) were associated with DRFS in both the 6-year [osteopenia HR 0.82 (95% CI 0.45–1.49), osteoporosis HR 1.10 (95% CI 0.26–4.67)] and the 3-year arm [osteopenia HR 0.75 (95% CI 0.40–1.42), osteoporosis HR 1.86 (95% CI 0.43–8.01)]. Moreover, bisphosphonate use did not impact DRFS. Conclusion No association was observed between a reduced BMD and DRFS. Neither did we observe an impact of bisphosphonates on DRFS.