Relative bone loss during aromatase inhibitors therapy: The B-ABLE cohort.

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579 Background: Estrogen deprivation induced by aromatase inhibitors (AI) leads to a rapid and prolonged bone loss and increased fracture incidence. The current study aims to evaluate AI-associated bone loss throughout the first two years of the treatment. Methods: B-ABLE is a prospective cohort of caucasian, postmenopausal women with early breast cancer, in adjuvant treatment with AI (according to the ASCO guidelines). Bone mineral density (BMD) and x-ray were measured at baseline and every year up to and 1 year after treatment completion. Paired t-tests were carried out to detect differences in lumbar spine (LS) and femoral neck (FN) BMD loss of 1 and 2 years of follow-up relative to baseline. Bisphosphonate users were excluded for these analyses. Women over 65 years old were also excluded from the analyses of LS BMD to avoid the underestimation of bone loss due to osteoarthritis. Results: Patients had mean rates of LS BMD loss relative to baseline of 1.98% (n=241) at 1 year and 3.51% (n=182) at 2 years of follow-up, (P<0.001). Mean rates BMD loss for FN were 1.24% (n=381) at 1 year and 2.07% (n=257) at 2 years, (P<0.001). Previous tamoxifen treated patients (40.7%) were younger and had a higher baseline BMD but experienced higher LS BMD loss rates at 1 (83%, P<0.05) and 2 (92%, P<0.001) years. FN BMD loss rates were also higher for those patients previously treated with tamoxifen at 1 (349%, P<0.001) and 2 years (177%, P<0.01). Conclusions: Rapid bone loss occurs in the first 2 years of AI treatment, especially in tamoxifen pre-treated women.

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