Causes of Bone Loss in Breast Cancer Survivors Identified

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Source: Loyola University Health System

Released: Wed 19-Nov-2008, 19:25 ET

Causes of Bone Loss in Breast Cancer Survivors Identified

http://www.newswise.com/articles/view/546654/?sc=rsmn

Description

Osteoporosis is a growing concern among breast cancer survivors and

their doctors, because certain cancer drugs can cause bone loss. But a

new study has found that cancer drugs aren't the only culprits. Among 64

breast cancer patients referred to a bone health clinic, 78 percent had

at least one other cause of bone loss, such as vitamin D deficiency or

an overactive parathyroid gland.

Newswise — Osteoporosis is a growing concern among breast cancer

survivors and their doctors, because certain cancer drugs can cause bone

loss.

But a new study has found that cancer drugs aren't the only culprits.

Among 64 breast cancer patients referred to a bone health clinic, 78

percent had at least one other cause of bone loss, including vitamin D

deficiency, excessive calcium excretion in urine and an overactive

parathyroid gland.

" Doctors evaluating breast cancer patients for possible bone loss should

look further than cancer drugs, " said Dr. ine Camacho, lead author

of the study in the Journal of Clinical Oncology. Camacho is an

associate professor in the department of medicine, division of

endocrinology and metabolism, Loyola University Chicago Stritch School

of Medicine.

A co-author of the study, Dr. Kathy Albain, said breast cancer survivors

" are just like the normal population as they age in that bone loss can

be due to many treatable causes. " Albain is a professor in the

Department of Medicine, division of hematology/oncology at Stritch.

Previous studies have found that chemotherapy drugs can cause bone loss.

Studies also have found that a class of breast cancer drugs called

aromatase inhibitors can decrease bone mineral density and increase the

risk of fractures in postmenopausal women. Aromatase inhibitors decrease

the body's production of estrogen. While estrogen feeds cancer, it also

protects against osteoporosis. Aromatase inhibitors include letrozole

(trade name, Femara), anastrazole (Arimidex) and exemestane (Aromasin).

Researchers reviewed charts of 238 consecutive postmenopausal patients

who had osteoporosis or osteopenia and were referred to the Loyola's

Osteoporosis and Metabolic Bone Disease Center from 2000 to 2006.

(Osteopenia is lower than normal bone mineral density, but not low

enough to be classified as osteoporosis.) The patients included 64 women

with breast cancer referred from Loyola's Cardinal Bernardin Cancer

Center and 174 patients without breast cancer referred from primary care

physicians.

Thirty eight percent of the breast cancer patients had vitamin D

deficiency, compared with 51 percent of the non breast cancer patients.

Another cause of osteoporosis, excessive calcium excretion in urine, was

found in 16 percent of cancer patients and 8 percent of noncancer

patients. And in 5 percent of patients, the parathyroid gland was

overactive, producing a hormone that causes bone to lose calcium.

Vitamin D deficiency can be treated with prescription doses of vitamin D

supplements. Excessive calcium excretion can be treated with a " water

pill " that's also used to treat high blood pressure, Camacho said. There

are various treatments for parathyroid gland disorder, depending on its

cause.

In certain breast cancer patients, bone loss from cancer drugs can be

treated with osteoporosis drugs such as alendronate sodium (Fosamax) and

ibandronate sodium (Boniva), Camacho said.

Albain refers all her breast cancer patients for a comprehensive bone

health evaluation when osteopenia or osteoporosis is discovered. " Just

prescribing a medication for osteoporosis may not be enough for many of

our patients, " Albain said. " They deserve a thorough workup. "

Patient leen O'Connor, 71, of Elmhurst, Il., learned she had

osteoporosis while being treated by Albain for breast cancer. Albain

referred O'Connor to Camacho, who prescribed calcium supplements,

prescription vitamin D and the osteoporosis drug Boniva. Three years

after O'Connor was diagnosed, her Stage 3 cancer is in remission, and

she has suffered no bone fractures.

Other authors of the study, all from Loyola, are Dr. Amit Dayal, Dr.

fina , Dr. Fadi Nabhan, Dr. Agarwal, Dr. Norton and

Dr. .

The study was presented as a poster in the 2007 meeting of the American

Society of Bone and Mineral Research in Honolulu. It was supported by an

investigator-initiated grant from Procter and Gamble.

Based in the western suburbs of Chicago, Loyola University Health System

is a quaternary care system with a 61-acre main medical center campus,

the 36-acre Gottlieb Memorial Hospital campus and 22 primary and

specialty care facilities in Cook, Will and DuPage counties. The medical

center campus is conveniently located in Maywood, 13 miles west of the

Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the

medical center campus, Loyola University Hospital, is a 570-licensed bed

facility. It houses a Level 1 Trauma Center, a Burn Center and the

Mc® Children’s Hospital of Loyola University Medical

Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola

Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral

Health Center as well as the LUC Stritch School of Medicine, the LUC

Marcella Niehoff School of Nursing and the Loyola Center for Health &

Fitness. Loyola's Gottlieb campus in Melrose Park includes the 250-bed

community hospital, the Gottlieb Health & Fitness Center and the

Marjorie G. Weinberg Cancer Care Center.

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