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Breast Cancer Res Treat. 2020 Apr;180(3):675-685. doi: 10.1007/s10549-020-05567-9. Epub 2020 Mar 2.

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

Author information

1
Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
2
Department of Internal Medicine, Medical Centre Alkmaar, Alkmaar, The Netherlands.
3
Biostatistics, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
4
Clinical Research Department, Netherlands Comprehensive Cancer Organization IKNL, Utrecht, The Netherlands.
5
Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
6
Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands.
7
Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands.
8
Department of Medical Oncology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
9
Department of Medical Oncology, Isala Clinics, Zwolle, The Netherlands.
10
Department of Medical Oncology, Zuyderland Medical Centre, Sittard, The Netherlands.
11
Department of Medical Oncology, Zuyderland Medical Centre, Heerlen, The Netherlands.
12
Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands.
13
Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
14
Department of Medical Oncology, Deventer Hospital, Deventer, The Netherlands.
15
Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands. vcg.tjan.heijnen@mumc.nl.
16
Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. vcg.tjan.heijnen@mumc.nl.

Abstract

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.

KEYWORDS:

Aromatase inhibitor; Bisphosphonates; Bone health; Bone metastases; Breast cancer; Distant recurrence-free survival; Osteoporosis; Survival; Tamoxifen

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