Bone health after breast cancer - PowerPoint Presentation

Slide1

Bone health after breast cancer

Studies and Recommendations

April 30, 2012Slide2

Bone Health Overview

Dynamic state of bone

resorption

(breaking down bone) and formation

When the rate of

resorption

is greater than formation, bone loss occursSlide3

Measuring Bone Health

Bone Mineral Density (BMD) is generally the measure of bone health

BMD looks at the amount of mineral matter per square centimeter of bone

DEXA scanner is used to measure BMDSlide4

World Health Organization Online Tool

The WHO developed an online tool that evaluates risk for fracture

Web address:

http

://

www.shef.ac.uk/FRAX/tool.jsp?country=9Slide5

Bone Effects of Adjuvant Therapies

Bone loss comes with age and onset of menopause, but accelerated by cancer treatments

Chemotherapy

can cause early onset of menopause, which increases the risk of fracture

Hormone

therapies

have different effects:

Tamoxifen

can help protect against bone

loss

In bone cells, it mimics the effects of estrogen, which helps with bone formation

Aromatase inhibitors

speed up bone loss

Absence of estrogen causes more

resorption

of the bone

“What Breast Cancer Survivors Need to Know About Osteoporosis.” 2011. http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/Conditions_Behaviors/osteoporosis_breast_cancer.asp

Tamoxifen

Use and Osteoporotic Fracture

Risk: A

Population-Based

Analysis.

Journal of Clinical Oncology.

http

://jco.ascopubs.org/content/26/32/5227.full.pdf+htmlSlide6

Guidelines on screening

Bone Mineral Density monitoring recommended for women who:Are older than 65

Have had breast cancer and have high risk factors (such as family history of fractures)

Are receiving aromatase inhibitor

Have had therapy-induced

ovarian failure

NCCN Task Force Report: Bone Health in Cancer Care.

2009;7:S-1-S-32

J Natl Compr Canc Netw

http://www.jnccn.org/content/7/Suppl_3/S-1.full.pdf+htmlSlide7

Improving Bone Health

Nutritional Supplements ExerciseStrength-training

If necessary, other pharmacological therapiesSlide8

What is recommended for supplements?

Total daily calcium intake of

at least 1000 mg per day for individuals under 50 years of age without major osteoporosis risk factors, and at least 1200 mg per day for those older than 50 years

Calcium is critical for bone mineralization

800

to 1,000 international units (IU) of vitamin D per day for adults aged 50 and older

Vitamin D is important for absorption of calcium through the stomach and intestines

NCCN Task Force Report: Bone Health in Cancer Care.

2009;7:S-1-S-32

J Natl Compr Canc Netw

http://www.jnccn.org/content/7/Suppl_3/S-1.full.pdf+htmlSlide9

Exercise and Strength-training

Both shown to improve bone health A recent study in Germany showed that an aerobics and strength-training exercise intervention for women over the age of 65 significantly improved bone health (BMD and fall risk)

Compared this group with a similar group receiving a wellness intervention

Exercise

Effects on Bone Mineral Density, Falls, Coronary Risk Factors, and Health Care Costs in Older

Women.

Arch Intern Med.

 2010;170(2):179-185.

http

://

archinte.ama-assn.org/cgi/content/full/170/2/179Slide10

Strength-training

A recent

s

tudy of progressive, moderate-intensity

resistance

with

impact

training showed it to slow bone density loss among post-menopausal breast cancer survivors

Examples of these exercises: using dumbbells, lunges, modified push-ups

Strength-training also shown to reduce

the risk of lymphedema for women who have had breast surgery

Strength training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized, controlled trial. Breast Cancer Res Treat (2011) 127:447–456.

http://

www.springerlink.com/content/548814073xqg4mj0/fulltext.pdf

Weight

Lifting in Women with

Breast-Cancer–Related Lymphedema. The New England Journal of Medicine. (2009

) 361;7.

http://

www.nejm.org/doi/pdf/10.1056/NEJMoa0810118

. Slide11

Medications to Prevent Bone Loss

If lifestyle and exercise do not improve bone health, other treatments may be used

Some osteoporosis medications also used to make the bone an inhospitable environment for cancer (prevent cancer from entering the bone)

E.g.

Zometa

,

denosumab

NCCN Task Force Report: Bone Health in Cancer Care.

2009;7:S-1-S-32

J Natl Compr Canc Netw

http://www.jnccn.org/content/7/Suppl_3/S-1.full.pdf+htmlSlide12

Sources

WHO FRAX Online Tool http

://

www.shef.ac.uk/FRAX/tool.jsp?country=9

“What Breast Cancer Survivors Need to Know About Osteoporosis.” 2011. National Institutes of Health Osteoporosis and Related Bone

Diseases

http

://

www.niams.nih.gov/Health_Info/Bone/Osteoporosis/Conditions_Behaviors/osteoporosis_breast_cancer.asp

Tamoxifen

Use and Osteoporotic Fracture Risk: A Population-Based Analysis. Andrew L. Cooke, Colleen

Metge

, Lisa

Lix

, Heather J. Prior, and William D.

Leslie.

Journal

of Clinical Oncology.

26:5227-5232

.

http

://

jco.ascopubs.org/content/26/32/5227.full.pdf+html

NCCN Task Force Report: Bone Health in Cancer Care.

2009;7:S-1-S-32

J Natl Compr Canc Netw

http://

www.jnccn.org/content/7/Suppl_3/S-1.full.pdf+html

Exercise Effects on Bone Mineral Density, Falls, Coronary Risk Factors, and Health Care Costs in Older Women

.

Wolfgang

Kemmler

, PhD; Simon von Stengel, PhD; Klaus

Engelke

, PhD;

Lothar

Häberle

, PhD;

Willi

A.

Kalender

, PhD, MD

Archives of Internal Medicine.

 2010;170(2):179-185.

http://archinte.ama-assn.org/cgi/content/full/170/2/179

Strength

training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized, controlled trial

.

Kerri M.

Winters-Stone,

Jessica

Dobek

, Lillian Nail,

Jill A.

Bennett,

Michael C.

Leo,

Arpana

Naik

,

Anna

Schwartz.

Breast Cancer

Research and Treatment

(2011) 127:447–456.

http://www.springerlink.com/content/548814073xqg4mj0/fulltext.pdf

Weight Lifting in Women with Breast-Cancer–Related Lymphedema

.

Kathryn H. Schmitz, Ph.D., M.P.H.,

Rehana

L. Ahmed, M.D., Ph.D

., Andrea

Troxel

, Sc.D., Andrea

Cheville

, M.D., Rebecca Smith, M.D

.,

Lorita

Lewis-Grant, M.P.H., M.S.W., Cathy J. Bryan,

M.Ed

.,Catherine

T. Williams-Smith, B.S., and Quincy P. Greene

The New England Journal of Medicine

. (2009) 361;7.

http://www.nejm.org/doi/pdf/10.1056/NEJMoa0810118