Exposure to alendronate is associated with a lower risk of bone metastases in osteoporotic women with early breast cancer

Background: Bisphosphonate (BP) treatment to prevent bone loss in breast cancer patients is already well established. However, data on the association between oral BP exposure before cancer diagnosis and disease outcomes in patients with early breast cancer are still scarce. Limited information is available on alendronate, the most common oral agent for the treatment of post-menopausal osteoporosis, regarding the association with bone metastases. Aim: To examine the association between oral bisphosphonate exposure before cancer diagnosis and the risk of bone metastases in osteoporotic women diagnosed with early breast cancer. Subjects and methods: This historical cohort study was conducted at the oncology division at Tel Aviv Medical Center. The study population included post-menopausal women with early breast cancer, diagnosed between 2002 and 2012. Data on cancer characteristics, diagnosis of osteoporosis, prior bisphosphonate exposure and outcome were collected from medical files. Results: Among 297 osteoporotic women identified, 145 (49%) were treated with bisphosphonates (alendronate in 90% of the cases) before cancer diagnosis. BP-treated women were significantly older than the BP-naïve ones (67.9 years vs 64.6 years, p = 0.01), but comparable in risk factors and disease characteristics. Over a mean follow up of 5.6 years, nine cases of bone metastases were identified, eight of them among BP-naïve patient (cumulative incidence of 9.9%) and one among BP-treated patients (0.7%). In a multivariable Cox's proportional hazards survival model the use of BP prior to cancer diagnosis was associated with a hazard ratio of 0.04 (95%CI:0.004–0.403, p = 0.006) for bone metastasis. The HR remained similar after further adjustment for tumor stage and cancer therapy. Conclusions: History of alendronate use is associated with a lower likelihood of bone metastases in postmenopausal women with early breast cancer. Oral bisphosphonate treatment could be sufficient for reducing the risk of bone metastases. Keywords: Bisphosphonates, Alendronate, Breast cancer, Bone metastase

Quantitative MR Analysis of Changes in the Radius Bone Marrow in Osteoporosis

Purpose. This pilot study aimed to explore the feasibility of scanning the human distal radius bone marrow in vivo to detect osteoporosis-related changes using magnetic resonance and evaluate whether the radius may serve as an accessible probing site for osteoporosis. This may lead in the future to the use of affordable means such as low-field MRI scanners for the monitoring of disease progression. Methods. A clinical trial was performed using a 3T MR scanner, including 26 women assigned into three study groups: healthy-premenopausal (n = 7; mean age 48.6 ± 3.5 years), healthy-postmenopausal (n = 10; mean age 54.5 ± 5.6 years), and osteoporotic-postmenopausal (n = 9; mean age 61.3 ± 5.6 years). Marrow fat composition was evaluated using T2 maps, a two-compartment model of T1, and a Dixon pulse sequence. Results. The osteoporotic group exhibited higher fat content than the other two groups and lower T2 values than the healthy-premenopausal group. Conclusions. Osteoporosis-related changes in the composition of the distal radius bone marrow may be detected in vivo using MRI protocols. The scanning protocols chosen here can later be repeated using low-field MRI scanners, thus offering the potential for early detection and treatment monitoring, using an accessible, affordable means that may be applied in small clinics. This trial is registered with MOH_2018-05-23_002247, NCT03742362

Validation of a multi-frequency bioelectrical impedance analysis device for the assessment of body composition in older adults with type 2 diabetes

10.1038/s41387-022-00223-1NUTRITION & DIABETES12

Bisphosphonates Use and Risk of Hip Fractures

Background: Osteoporosis affects 200 million women worldwide, and fractures resulting from bone fragility are a major complication. Bisphosphonates slow down bone resorption by osteoclasts and have been shown to lower the risk of hip fractures among patients with osteoporosis in clinical trial settings. Most clinical guidelines recommend pharmacological treatment for postmenopausal women with an existing fracture or bone density T-score of -2.5 or lower. These guidelines were based on randomized controlled trials that typically lasted 3–4 years, although some of these studies have been extended for up to 10 years. We undertook this study to examine the association between adherence with bisphosphonate therapy and long-term risk of hip fracture, using up to 14 years of retrospective observation. Methods: Included in the present nested case-control study were osteoporotic women (N = 14,357) who initiated bisphosphonate therapy between the years 2000 and 2010 and were retrospectively followed for incident hip fracture through November 2014. All cases of primary hip fracture within the cohort (n = 411) were individually matched with 411 controls based on age (± 1 year) and calendar year at therapy initiation as well as follow-up duration (± 1 year). For each study participant, the total dispensed packs of bisphosphonates during the follow-up period were counted. Results: Compared to patients discontinuing therapy within 1 month, therapy with bisphosphonates for 1 to 3 years and 3 to 6 years was associated with adjusted odds ratios (and 95% confidence intervals) for hip fractures of 0.48 (0.27–0.86) and 0.40 (0.22–0.73), respectively. Comparable odds ratios were calculated for patients covered for longer periods –– 0.36 (0.17–0.76) for 6 to 8 years, and 0.57 (0.27–1.21) for 8 years or more. Conclusion: Results suggest that 3 years or more of bisphosphonates use is associated with a substantially lower risk of primary hip fracture compared to nonpersistent patients. The results do not indicate further reduction in risk among patients treated for 8 years or more

Role of Side Effects, Physician Involvement, and Patient Perception in Non-Adherence with Oral Bisphosphonates

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