Prospective Study Evaluating Changes in Bone Quality in Premenopausal Women With Breast Cancer Undergoing Adjuvant Chemotherapy

Clin Breast Cancer. 2020 Jun;20(3):e327-e333. doi: 10.1016/j.clbc.2019.12.001. Epub 2019 Dec 5.

Abstract

Background: Ovarian suppression from chemotherapy results in bone loss in premenopausal women with breast cancer (BC). Less is known about bone microarchitecture changes. We used high-resolution peripheral quantitative computed tomography (HR-pQCT) to measure volumetric bone density and trabecular and cortical microarchitecture in this population.

Materials and methods: The primary endpoint was to assess changes in cortical thickness and trabecular bone density by HR-pQCT. Premenopausal women with stage I to III BC undergoing adjuvant chemotherapy underwent a bone mineral density (BMD) dual energy x-ray absorptiometry scan and HR-pQCT (voxel size, 82 microns) at baseline and 12 months. Paired t tests were used to observe the change over time in bone microarchitecture and areal and volumetric density.

Results: Eighteen patients were evaluated, of which 12 patients had baseline and matched 12-month imaging. The mean age was 45.2 years (range, 35-51 years), 17 (94%) patients had hormone receptor-positive BC, and 16 (89%) initiated tamoxifen. At 12 months, there was a significant decrease in femoral neck (P < .05) and lumbar spine and total hip (P < .01) BMD. Changes detected by HR-pQCT at 12 months included significant decreases in cortical thickness and area at the tibia (P < .05), and total and cortical volumetric BMD at the radius and tibia (P < .01), as well as an increase in tibial trabecular area (P < .05).

Conclusion: Premenopausal women undergoing chemotherapy experience BMD decline and trabecular and cortical bone microarchitecture deterioration. In this population, future efforts should focus on therapy-induced bone loss and optimizing bone density-related management.

Keywords: Bone microarchitecture; Cortical thickness; DXA; HR-pQCT; Trabecular bone density.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon
  • Adult
  • Bone Density / drug effects*
  • Breast Neoplasms / therapy*
  • Cancellous Bone / diagnostic imaging
  • Cancellous Bone / drug effects*
  • Cancellous Bone / physiopathology
  • Chemotherapy, Adjuvant / adverse effects
  • Chemotherapy, Adjuvant / methods
  • Cortical Bone / diagnostic imaging
  • Cortical Bone / drug effects*
  • Cortical Bone / physiopathology
  • Female
  • Femur Neck / diagnostic imaging
  • Femur Neck / drug effects
  • Hip Joint / diagnostic imaging
  • Hip Joint / drug effects
  • Humans
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / drug effects
  • Mastectomy
  • Middle Aged
  • Osteoporosis / chemically induced
  • Osteoporosis / diagnosis*
  • Premenopause
  • Prospective Studies
  • Radius / diagnostic imaging
  • Radius / drug effects
  • Tibia / diagnostic imaging
  • Tibia / drug effects
  • Tomography, X-Ray Computed