Adjuvant endocrine therapy is the treatment for estrogen-receptor (ER)-positive breast cancer (BC). Aromatase inhibitors (AIs) reduce recurrence risk but accelerate bone loss and fracture risk. Denosumab (DmAb), an antiresorptive agent, shows promise in mitigating these effects. To assess the short-term effects of DmAb and AIs on bone health in ER-positive BC patients using Radiofrequency Echographic Multi-Spectrometry (REMS) compared with DXA. Post-menopausal BC patients receiving AIs who were referred for osteoporosis assessment were retrospectively identified and classified into 2 groups according to routine clinical management: patients receiving DmAb (Group A) or any anti-osteoporotic treatment (Group B). Bone health was evaluated at baseline (T0) and after 6 (T1), 12 (T2), and 18 months (T3). DXA was performed at T0 and T2, while REMS was also performed at T1 and T3. 364 patients were included in the study. Group B showed a progressive decline in spine and femoral BMD, detected at all time points. Conversely, Group A exhibited significant BMD improvements at both skeletal sites, observed at all time points. Over 18 months, lumbar spine REMS-BMD decreased of -3.92%±0.88% (p < 0.0001) in Group B and increased by 5.28%±0.73% (p < 0.0001) in Group A. Comparable trends were observed at the femoral site. This study, for the first time, quantifies the short-, medium- and long-term AIs effects on bone loss and the positive impact of DmAb on bone density recovery without radiation exposure. These findings support REMS as a reliable tool for longitudinal monitoring of treatment response in patients receiving anti-osteoporosis therapy.
Caffarelli et al. (Mon,) studied this question.