Terapia adiuvante con anastrazolo nella donna anziana con carcinoma mammario precoce: Rischio di frattura e ruolo protettivo del risedronato

Objectives. To evaluate the effect of aromatase inhibitors on bone mineral density (BMD) and risk of bone fractures in women over-70 with early breast cancer (EBC), and to verify usefulness of bisphosphonates. Methods. 26 elderly women aged 77.2 ± 5 ys candidate to adjuvant IAs (anastrazole 1 mg/die) for EBC were enrolled. Femoral and lumbar spine DEXA, and morphometric evaluation of vertebral bodies were performed in all patients and repeated after 1 year. 13 patients with T-score > -2 and without fractures (group A) received calcium (1000 mg/die) and 25-OH-D3 (800 UI/die). 13 patients with T-score ≤ -2 or T-score > -2 and vertebral fractures (group B) were given in addition risedronic acid (35 mg/week). Results. In group A, at 1-year follow-up, no patients showed modification of lumbar and femoral-neck BMD, while throcanter (Δ BMD: -0.021 ± 0.020, p <0.01) and total hip (Δ BMD: -0.011 ± 0.018, p <0.05) BMD decreased significantly. In group B BMD was stable in all femoral sites, while lumbar BMD significantly increased (Δ BMD L2-L4: + 0.029 ± 0.04, p <0.05). No patients developed vertebral or other fractures during the follow-up. Conclusions. Short/medium-term treatment with aromatase inhibitors in elderly women with EBC causes minimal detrimental impact on bone. Concomitant use of bisphosphonates like risedronic acid allows a safe use of aromatase inhibitors also in elderly patients.