Preventing bone loss in patients treated for breast cancer

Almost 30,000 postmenopausal women in the UK develop breast cancer each year. Aromatase inhibitors (AIs) are a class of drug that significantly improve their survival rate.

Research undertaken by the University of Manchester confirmed, however, that women taking AIs after their initial cancer treatment often develop osteoporotic fractures and suffer from loss of bone mineral density.

As a result of the outcomes of three major clinical trials conducted by Nigel Bundred, Professor of Surgical Oncology, there are now internationally-adopted standards of care guidelines which:

• Recommend the use of DEXA (dual energy X-Ray absorptiometry) scanning to identify patients at risk of bone loss, before starting AI therapy
• Advise the use of bisphosphonates (drugs which slow down or prevent bone damage) where bone loss has been identified
• Advise against the use of HRT (hormone replacement therapy) to treat bone loss in breast cancer patients

In the UK, NICE adopted the recommendation for DEXA scanning in patients with early invasive breast cancer in the 2009 guidelines 'Early and locally advanced breast cancer: Diagnosis and Treatment'. It also advocated the immediate administration of bisphosphonates for women receiving AI treatment, in order to prevent loss of bone mineral density.

A number of US guidelines cited the team's research and recommend the administration of DEXA scanning and bisphosphonates in patients on AI therapy after breast cancer treatment. This change in practice has now been adopted worldwide.

Professor Bundred's research, in collaboration with Professor Tony Howell, also contributed to the discontinuation of HRT for use after breast cancer diagnosis. It is now recognised that HRT should no longer be used for breast cancer patients who have menopausal symptoms or bone loss.

“In the UK NICE adopted the recommendation for DEXA (dual energy X-Ray absorptiometry) scanning in patients with early invasive breast cancer in the 2009 guidelines 'Early and locally advanced breast cancer: Diagnosis and Treatment'.”

Nigel Bundred / Professor of Surgical Oncology