Management of aromatase inhibitor-associated bone loss (AIBL) in women with hormone-sensitive breast cancer: An updated joint position statement of the IOF, CABS, ECTS, IEG, ESCEO, IMS, and SIOG

IF 3.5 2区医学 Q2 Medicine

Journal of Bone Oncology Pub Date : 2025-06-11 DOI:10.1016/j.jbo.2025.100694

Peyman Hadji , Matty Aapro , Nasser Al-Dagri , Majed Alokail , Emmanuel Biver , Jean-Jacques Body , Maria Luisa Brandi , Janet Brown , Cyrille Confavreux , Bernard Cortet , Matthew Drake , Peter Ebeling , Erik Fink Eriksen , Ghada El-Hajj Fuleihan , Theresa A. Guise , Nick C. Harvey , Andreas Kurth , Bente Langdahl , Willem Lems , Radmila Matijevic , Robert Coleman

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引用次数: 0

Abstract

Background

Women with hormone-responsive breast cancer who receive adjuvant endocrine treatment with aromatase inhibitors (AI) are known to be at higher fracture risk due to a marked increase in bone resorption. In 2017, several interdisciplinary cancer and bone societies involved in the management of women with AI-associated bone loss (AIBL) published a joint position statement comprising evidence-based recommendations and a practical management algorithm for the assessment of fracture risk and optimal treatment of this patient population.

Patients and methods

In order to provide updated recommendations that reflect recent advances in the assessment and management of AIBL since publication of the 2017 joint position statement, a systematic literature review was undertaken to identify relevant studies for analysis, including systematic reviews and meta-analyses. Individual trials identified were assessed for their level of evidence based on design, size, follow-up, and evaluation of safety, as well as the impact of bone directed treatments on breast cancer outcomes.

Results

New evidence was combined with the existing recommendations to provide an updated joint position statement regarding fracture risk assessment and implementation of bone-directed therapy.

Conclusion

Current published literature, including recent clinical trial reports, systematic reviews and meta-analyses, continue to affirm the high risk of fractures in women with breast cancer who are receiving adjuvant AI treatment, a risk which has been observed to increase with the commonly used approach of extended duration AI therapy (>5 years). Risk factors for fracture and risk assessment in this patient population as well as the most suitable treatment modalities have been updated. Finally, the influence of bone protective treatments on breast cancer outcomes such as incidence of bone metastasis and breast cancer related overall survival have been included.

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激素敏感性乳腺癌女性芳香化酶抑制剂相关性骨质流失（AIBL）的管理：IOF、CABS、ECTS、IEG、ESCEO、IMS和SIOG的最新联合立场声明

研究背景：患有激素反应性乳腺癌的女性接受芳香酶抑制剂（AI）辅助内分泌治疗后，由于骨吸收显著增加，骨折风险更高。2017年，参与人工智能相关性骨质流失（AIBL）女性管理的几个跨学科癌症和骨骼学会发表了一份联合立场声明，其中包括基于证据的建议和实用的管理算法，用于评估该患者群体的骨折风险和最佳治疗。自2017年联合立场声明发布以来，为了提供反映AIBL评估和管理最新进展的最新建议，我们进行了系统的文献综述，以确定相关研究进行分析，包括系统综述和荟萃分析。根据设计、规模、随访、安全性评估以及骨导向治疗对乳腺癌预后的影响，对已确定的单个试验的证据水平进行了评估。结果新的证据与现有的建议相结合，为骨折风险评估和骨导向治疗的实施提供了一个更新的关节位置声明。目前已发表的文献，包括近期的临床试验报告、系统综述和荟萃分析，都继续证实接受辅助人工智能治疗的乳腺癌女性骨折风险较高，并且随着常用的人工智能治疗时间延长（5年），骨折风险增加。骨折的危险因素和该患者人群的风险评估以及最合适的治疗方式已经更新。最后，骨保护治疗对乳腺癌预后的影响，如骨转移发生率和乳腺癌相关总生存期。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Bone Oncology ONCOLOGY-

CiteScore

7.20

自引率

2.90%

发文量

审稿时长

34 days

期刊介绍： The Journal of Bone Oncology is a peer-reviewed international journal aimed at presenting basic, translational and clinical high-quality research related to bone and cancer. As the first journal dedicated to cancer induced bone diseases, JBO welcomes original research articles, review articles, editorials and opinion pieces. Case reports will only be considered in exceptional circumstances and only when accompanied by a comprehensive review of the subject. The areas covered by the journal include: Bone metastases (pathophysiology, epidemiology, diagnostics, clinical features, prevention, treatment) Preclinical models of metastasis Bone microenvironment in cancer (stem cell, bone cell and cancer interactions) Bone targeted therapy (pharmacology, therapeutic targets, drug development, clinical trials, side-effects, outcome research, health economics) Cancer treatment induced bone loss (epidemiology, pathophysiology, prevention and management) Bone imaging (clinical and animal, skeletal interventional radiology) Bone biomarkers (clinical and translational applications) Radiotherapy and radio-isotopes Skeletal complications Bone pain (mechanisms and management) Orthopaedic cancer surgery Primary bone tumours Clinical guidelines Multidisciplinary care Keywords: bisphosphonate, bone, breast cancer, cancer, CTIBL, denosumab, metastasis, myeloma, osteoblast, osteoclast, osteooncology, osteo-oncology, prostate cancer, skeleton, tumour.