Zoledronic Acid Prevents Bone Loss During Treatment for Breast Cancer

According to a study report from the Austrian Breast and Colorectal Cancer Study Group trial-12 (ABCSG-12), published online August 20 in Lancet Oncology, premenopausal women undergoing breast cancer treatment were able to prevent bone loss when Zolendronic acid was given in conjunction with chemotherapy. The study also reports that bone mineral density improved five years after treatment was discontinued.

Previous studies have shown that Zoledronic acid also prevents early breast cancer relapses, when combined with endocrine therapy. In the current study, designed to measure the effects of the drug on bone mineral density, the researchers also found that even more significant improvements two years after ending treatment.

Michael Gnant, MD, professor of surgery at the Medical University of Vienna and president of the Austrian Breast and Colorectal Cancer Study Group says, "With endocrine therapy for premenopausal women, there is substantial bone loss... this can be corrected with an easy and harmless treatment. We do recommend adjuvant zoledronic acid for the exact patient group described in this trial."

Study participants who received endocrine therapy alone were found to lose 11.3% and 7.3% of baseline lumbar spine and trochanter bone density respectively. Two years after treatment, there was no improvement. However, the women who received zoledronic acid showed improvement in bone density in both areas after 60 months.

The Importance of Strong Bones

Loss of bone density results in osteoporosis. Osteopenia is the term used for decreased bone mass. Bone mineral density tests measure the health of your bones, and are important in measuring a persons’ risk for fracture and injury – a problem that can cause permanent disability.

Risk factors include the use of certain medications, conditions such as anorexia, smoking and alcohol, family history, advancing age, and being Caucasian or Asian.

Though bone mineral density may return in women receiving breast cancer treatment, the author of the current study writes, “Currently, nobody can realistically say what consequence a long-term period of reduced bone-mineral density will have on later bone integrity." Anyone with chronic medical problems may be at risk. Ask your doctor for a bone density test if you have any risk factors or warning signs of bone loss or osteoporosis.

Source: Lancet Oncol. 2008; 9:840-849. Published online August 20, 2008.

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Zoledronic Acid Prevents Bone Loss During Treatment for Breast Cancer

Screening Men for Osteoporosis-New Clinician Guidelines

The American College of Physicians has issued guidelines for performing bone mass density tests in older men, recognizing that “osteoporosis if not just a woman’s disease”. Lead author, Amir Qaseem, MD, PhD, MHA concludes: "Older men, especially those over the age of 65, need to be assessed regularly for their risk of osteoporosis." The recommendations come about because of the increasing incidence of osteoporosis among men. The guidelines are published in the May 6 issue of the Annals of Internal Medicine.

Men, who experience fractures as the result of loss of bone mass, are twice as likely to die from complications when compared to women with fractures. The evidence comes from a review of articles published on MEDLINE from 1990 to 2007. Articles from experts were reviewed as well as other referenced material that evaluated risk fractures in men.

The osteoporosis foundation is urging clinicians to screen high-risk men from age 50 to 70 and all men over 70 by using a BMD or bone mass density test, also known as a DEXA scan. For men who have already suffered a fracture, BMD testing is recommended to determine the severity of the fracture.

Risk factors for men include androgen deprivation, spinal cord injury and advanced age. Sedentary lifestyle, poor dietary intake of calcium, low body mass index, weight loss of more than 10% and the use of prescription steroids are all indications that bone density should be viewed.

According to estimates, the incidence of osteoporosis in men is expected to increase by 50% during the next fifteen years, and the rate of hip fractures is expected to double. The current statistics for osteoporosis in men are 7%, 5% and 3% in whites, African –Americans and Hispanics respectively.

The risk of complications, the need for surgery and associated morbidity make routine screening a valuable tool for decreasing the burden of unnecessary injuries and hospitalization in men who are candidates for drug therapy to treat osteoporosis.

You doctor may now be asking questions about your calcium intake, tracking changes in your weight and insisting that more men get busy exercising to decrease the risk of osteoporosis. According to Dr. Qaseem, “Osteoporosis . . . is significantly under diagnosed and undertreated in men”. ◦

Screening Men for Osteoporosis-New Clinician Guidelines