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Increased fracture risk in women treated with aromatase inhibitors versus tamoxifen: beneficial effect of bisphosphonates

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dc.contributor.author Pineda-Moncusí, Marta
dc.contributor.author Garcia Giralt, Natàlia
dc.contributor.author Díez Pérez, Adolfo
dc.contributor.author Servitja Tormo, Sonia
dc.contributor.author Tusquets Trias de Bes, Ignacio
dc.contributor.author Prieto-Alhambra, Daniel
dc.contributor.author Nogués Solan, Francesc Xavier
dc.date.accessioned 2020-02-24T08:04:52Z
dc.date.issued 2020
dc.identifier.citation Pineda-Moncusí M, Garcia-Giralt N, Diez-Perez A, Servitja S, Tusquets I, Prieto-Alhambra D. et al. Increased fracture risk in women treated with aromatase inhibitors versus tamoxifen: beneficial effect of bisphosphonates. J Bone Miner Res. 2020 Feb; 35(2):291-7. DOI: 10.1002/jbmr.3886
dc.identifier.issn 0884-0431
dc.identifier.uri http://hdl.handle.net/10230/43688
dc.description.abstract Aromatase inhibitors have been associated with accelerated bone loss and an increased risk of osteoporotic fractures. Currently, bisphosphonates are recommended to reduce fracture risk in these patients. The aim of this study is to evaluate the fracture risk in breast cancer patients receiving aromatase inhibitors, compared to tamoxifen users, and to assess the effectiveness of oral bisphosphonates in reducing fracture risk. We performed an observational cohort study up to 10 years of follow-up. Data were extracted from primary care records in a population database. Women diagnosed with breast cancer between 2006 and 2015 and treated with tamoxifen or aromatase inhibitors (n = 36,472) were stratified according to low (without osteoporosis diagnosis nor bisphosphonates exposure) or high (with osteoporosis and/or treated with bisphosphonates) fracture risk. Cox models were used to calculate hazard ratios (HR [95% CI]) of fracture from the propensity score-matched patients. Sensitivity analyses account for competing risk of death were performed (subdistribution hazard ratio [SHR] [95% CI]). In postmenopausal women, fracture risk in aromatase inhibitor users showed an HR 1.40 [95% CI,1.05 to 1.87] and SHR 1.48 [95% CI, 1.11 to 1.98], compared to tamoxifen. Observing aromatase inhibitors patients at high risk of fracture, bisphosphonate-treated patients had an HR 0.73 [95% CI, 0.51 to 1.04] and SHR 0.69 [95% CI, 0.48 to 0.98] compared to nontreated. In conclusion, fracture risk in postmenopausal women during aromatase inhibitor treatment, in real-life conditions, was >40% compared to tamoxifen, corroborating previous randomized controlled trials results. In high-risk patients, bisphosphonate users had lower significant fracture incidence during aromatase inhibitor therapy than nonbisphosphonate users. Monitoring fracture risk and related risk factors in aromatase inhibitor patients is advisable. © 2019 American Society for Bone and Mineral Research.
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher Wiley
dc.rights This is the peer reviewed version of the following article: Pineda-Moncusí M, Garcia-Giralt N, Diez-Perez A, Servitja S, Tusquets I, Prieto-Alhambra D. et al. Increased fracture risk in women treated with aromatase inhibitors versus tamoxifen: beneficial effect of bisphosphonates. J Bone Miner Res. 2020 Feb; 35(2):291-7, which has been published in final form at http://dx.doi.org/10.1002/jbmr.3886. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
dc.title Increased fracture risk in women treated with aromatase inhibitors versus tamoxifen: beneficial effect of bisphosphonates
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1002/jbmr.3886
dc.subject.keyword Aromatase inhibitors
dc.subject.keyword Estrogems and serms
dc.subject.keyword Fracture prevention
dc.subject.keyword Fracture risk assessment
dc.subject.keyword General population studies
dc.rights.accessRights info:eu-repo/semantics/embargoedAccess
dc.type.version info:eu-repo/semantics/acceptedVersion
dc.embargo.liftdate 2021-02-28
dc.date.embargoEnd info:eu-repo/date/embargoEnd/2021-02-28

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