Changes in bone biomarker concentrations and musculoskeletal symptoms among breast cancer patients initiating aromatase inhibitor therapy and women without a history of cancer.

Lisa Gallicchio, Ryan MacDonald, Bethany Wood, Errol Rushovich, Neal S Fedarko, Kathy J. Helzlsouer

Research output: Contribution to journalArticle

Abstract

The objectives of this study were to examine: (1) changes in bone formation (osteocalcin) and bone resorption (cross-linked N-telopeptides of bone type I collagen [NTXs]) markers, as well as calcium, phosphorus, and intact parathyroid hormone, over the first 6 months of aromatase inhibitor (AI) therapy among a cohort of breast cancer patients compared with a group of unexposed women without a history of cancer; and (2) whether bone marker changes were associated with musculoskeletal pain. Eligible breast cancer patients (n = 49) and postmenopausal women without a history of cancer (n = 117) were recruited and followed for 6 months. At baseline, 3 months, and 6 months, a questionnaire was administered to assess pain and medication use, and a blood sample was drawn. Results showed that, among the breast cancer patients, calcium concentrations decreased significantly (-7.8% change; p = 0.013) and concentrations of NTXs increased significantly from baseline to 6 months (9.6% change; p = 0.012). Changes were not observed for women in the comparison group. Statistically significant differences in percent change between the breast cancer patients and the women in the comparison group were observed for calcium at 6 months (-7.8% versus 0.0%; p = 0.025), phosphorus at 6 months (-5.1% versus 16.7%; p = 0.003), NTXs at 6 months (9.6% versus -0.7%; p = 0.017), and osteocalcin at 6 months (11.5% versus -3.6%; p = 0.016). No statistically significant associations were observed between bone turnover marker changes and musculoskeletal pain among the breast cancer patients, although baseline NTXs were higher among women with onset or increase in pain compared with those reporting no pain (p = 0.08). Findings from this study suggest that AIs cause changes in bone turnover during the first 6 months of treatment; however, these changes are not associated with musculoskeletal pain. Breast cancer patients initiating AI therapy should be assessed and monitored for fracture risk using known clinical risk factors, including bone density, and managed appropriately.

Original languageEnglish (US)
Pages (from-to)1959-1966
Number of pages8
JournalJournal of Bone and Mineral Research
Volume27
Issue number9
StatePublished - Sep 2012
Externally publishedYes

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Aromatase Inhibitors
Biomarkers
Breast Neoplasms
Bone and Bones
Musculoskeletal Pain
Neoplasms
Bone Remodeling
Osteocalcin
Calcium
Pain
Phosphorus
Therapeutics
Bone Resorption
Collagen Type I
Parathyroid Hormone
Osteogenesis
Bone Density

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Changes in bone biomarker concentrations and musculoskeletal symptoms among breast cancer patients initiating aromatase inhibitor therapy and women without a history of cancer. / Gallicchio, Lisa; MacDonald, Ryan; Wood, Bethany; Rushovich, Errol; Fedarko, Neal S; Helzlsouer, Kathy J.

In: Journal of Bone and Mineral Research, Vol. 27, No. 9, 09.2012, p. 1959-1966.

Research output: Contribution to journalArticle

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title = "Changes in bone biomarker concentrations and musculoskeletal symptoms among breast cancer patients initiating aromatase inhibitor therapy and women without a history of cancer.",
abstract = "The objectives of this study were to examine: (1) changes in bone formation (osteocalcin) and bone resorption (cross-linked N-telopeptides of bone type I collagen [NTXs]) markers, as well as calcium, phosphorus, and intact parathyroid hormone, over the first 6 months of aromatase inhibitor (AI) therapy among a cohort of breast cancer patients compared with a group of unexposed women without a history of cancer; and (2) whether bone marker changes were associated with musculoskeletal pain. Eligible breast cancer patients (n = 49) and postmenopausal women without a history of cancer (n = 117) were recruited and followed for 6 months. At baseline, 3 months, and 6 months, a questionnaire was administered to assess pain and medication use, and a blood sample was drawn. Results showed that, among the breast cancer patients, calcium concentrations decreased significantly (-7.8{\%} change; p = 0.013) and concentrations of NTXs increased significantly from baseline to 6 months (9.6{\%} change; p = 0.012). Changes were not observed for women in the comparison group. Statistically significant differences in percent change between the breast cancer patients and the women in the comparison group were observed for calcium at 6 months (-7.8{\%} versus 0.0{\%}; p = 0.025), phosphorus at 6 months (-5.1{\%} versus 16.7{\%}; p = 0.003), NTXs at 6 months (9.6{\%} versus -0.7{\%}; p = 0.017), and osteocalcin at 6 months (11.5{\%} versus -3.6{\%}; p = 0.016). No statistically significant associations were observed between bone turnover marker changes and musculoskeletal pain among the breast cancer patients, although baseline NTXs were higher among women with onset or increase in pain compared with those reporting no pain (p = 0.08). Findings from this study suggest that AIs cause changes in bone turnover during the first 6 months of treatment; however, these changes are not associated with musculoskeletal pain. Breast cancer patients initiating AI therapy should be assessed and monitored for fracture risk using known clinical risk factors, including bone density, and managed appropriately.",
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AU - Fedarko, Neal S

AU - Helzlsouer, Kathy J.

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