Efficacy of Antiresorptive Drugs on Bone Mineral Density in Post-Menopausal Women With Early Breast Cancer Receiving Adjuvant Aromatase Inhibitors: A Systematic Review of Randomized Controlled Trials

Alessandro de Sire; Lorenzo Lippi; Konstantinos Venetis; Stefania Morganti; Elham Sajjadi; Claudio Curci; Antonio Ammendolia; Carmen Criscitiello; Nicola Fusco; Marco Invernizzi

doi:10.3389/fonc.2021.829875

Efficacy of Antiresorptive Drugs on Bone Mineral Density in Post-Menopausal Women With Early Breast Cancer Receiving Adjuvant Aromatase Inhibitors: A Systematic Review of Randomized Controlled Trials

Front Oncol. 2022 Jan 21:11:829875. doi: 10.3389/fonc.2021.829875. eCollection 2021.

Authors

Alessandro de Sire¹, Lorenzo Lippi², Konstantinos Venetis^{3

4}, Stefania Morganti^{3

5}, Elham Sajjadi^{3

4}, Claudio Curci⁶, Antonio Ammendolia¹, Carmen Criscitiello^{4

5}, Nicola Fusco^{3

4}, Marco Invernizzi^{2

7}

Affiliations

¹ Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy.
² Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy.
³ Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
⁴ Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
⁵ Division of Early Drug Development, IEO, European Institute of Oncology IRCCS, Milan, Italy.
⁶ Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, Mantova, Italy.
⁷ Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.

Abstract

Background: Cancer treatment-induced bone loss (CTIBL) is a frequent complication of breast cancer therapies affecting both disability and health-related quality of life (HRQoL). To date, there is still a lack of consensus about the most effective approach that would improve bone health and HRQoL. Therefore, the aim of this systematic review of randomized controlled trials (RCTs) was to summarize the evidence on the effects of antiresorptive drugs on CTIBL in patients with early breast cancer.

Methods: PubMed, Scopus, and Web of Science databases were systematically searched up to April 30, 2021 to identify RCTs satisfying the following PICO model: P) Participants: postmenopausal women with early breast cancer receiving adjuvant aromatase inhibitors (AI), age >18 years; I) Intervention: antiresorptive drugs (i.e. bisphosphonates and/or denosumab); C) Comparator: any comparator; O) Outcome: bone mineral density (BMD) modifications. Moreover, a quality assessment was performed according to the Jadad scale.

Results: Out of the initial 2415 records, 21 papers (15 studies) were included in the data synthesis. According to the Jadad scale, 6 studies obtained a score of 5, 1 study obtained a score of 4, 13 studies obtained a score of 3, and 1 study with score 1. Although both bisphosphonates and denosumab showed to increase BMD, only denosumab showed significant advantages on fractures.

Conclusions: Bone health management in patients with early breast cancer receiving adjuvant AIs remains challenging, and the optimal therapeutic approach is not standardized. Further studies are needed to investigate CTIBL, focusing on both the need for antiresorptive drugs and their duration based on individual patients' characteristics.

Systematic review registration: https://www.crd.york.ac.uk/prospero, identifier CRD42021267107.

Keywords: bone health; breast cancer; early breast cancer; osteoporosis; quality of life; rehabilitation.

Publication types

Systematic Review