Protective effect of bisphosphonate on the cortical bone at key locations of the femur in aromatase inhibitor-associated bone loss: A three-dimensional cortical bone mapping study

Namki Hong; Seung Won Burm; Graham Treece; Jee Ye Kim; Min Hwan Kim; Seunghyun Lee; Sungjae Shin; Yumie Rhee

doi:10.1016/j.jbo.2021.100409

Protective effect of bisphosphonate on the cortical bone at key locations of the femur in aromatase inhibitor-associated bone loss: A three-dimensional cortical bone mapping study

Namki Hong, Seung Won Burm, Graham Treece, Jee Ye Kim, Min Hwan Kim, Seunghyun Lee, Sungjae Shin, Yumie Rhee

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Aromatase inhibitor treatment in breast cancer is associated with accelerated bone loss and an increased risk of fracture. Bisphosphonates (BPs) are the mainstay treatment of aromatase inhibitor-associated bone loss (AIBL), which might improve femoral bone at key locations prone to fracture. To test this hypothesis, we performed three-dimensional cortical bone mapping based on quantitative computed tomography (QCT) scans in postmenopausal women with early breast cancer who were receiving aromatase inhibitors. Data of subjects who had both baseline and at least one follow-up QCT at Severance Hospital (South Korea) between 2005 and 2015 were analyzed (BP users, n = 93; BP non-users, n = 203). After exclusion of BP users with low medication persistence (proportion of days covered: <50%), BP users and non-users were 1:1 matched (n = 54 for each group) in terms of age, lumbar spine volumetric bone mineral density (LSvBMD), femoral neck areal BMD (FNaBMD), and total hip areal BMD (THaBMD). During a median follow-up of 2.1 years, BP use attenuated bone loss in LSvBMD (+7.2% vs. −3.8%, p < 0.001), FNaBMD (+1.3% vs. −2.7%, p < 0.001), and THaBMD (-0.3% vs. −2.5%, p = 0.024). BP had a protective effect on cortical parameters of femoral bone: estimated cortical thickness (CTh) (+3.3% vs. + 0.1%, p = 0.007) and cortical mass surface density (CMSD, cortical mass per unit surface area was calculated by multiplying cortical BMD with CTh) (+3.4% vs. −0.3%, p < 0.001). CMSD increased by up to 15% at key locations such as the superior part of the femoral neck and greater trochanter. BP prevented the thinning of average CTh of the femoral neck (-1.4% vs. −6.1%, p < 0.001), particularly at the superior anterior quadrant of femoral neck (absolute difference: +12.8% point vs. non-users). Compared to BP non-users, BP users had improved cross-sectional moment of inertia (+4.4% vs. −0.7%, p = 0.001) and less increase in buckling ratio (+1.3% vs. + 7.5%, p < 0.001). In summary, BP use prevented cortical bone deficits observed in AIBL at key locations of the proximal femur.

Original language	English
Article number	100409
Journal	Journal of Bone Oncology
Volume	32
DOIs	https://doi.org/10.1016/j.jbo.2021.100409
Publication status	Published - 2022 Feb

Bibliographical note

Funding Information:
We thank Keenan Brown (Mindways Software, Inc. TX, USA) for his insightful discussion and technical support. The data analyzed in this study are available upon reasonable request to the corresponding author (YR). This work was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety, the National Research Foundation of Korea) (Project Number:1711139101, KMDF_PR_20210527_0003), the faculty research grant of Yonsei University College of Medicine, Seoul, Korea (6-2019-0102), and Korean Endocrine Society for New Faculty Convergence Research Award 2019. The funding sources or sponsors had no involvement throughout the study. This study was approved by the institutional review board of Severance Hospital, Seoul, Korea (IRB no. 4-2018-0635), with the requirement for informed consent waived due to the fact that medical records were reviewed in this study. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and the 1964 Declaration of Helsinki and its later amendments.

Funding Information:
This work was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety, the National Research Foundation of Korea ) (Project Number: 1711139101 , KMDF_PR_20210527_0003), the faculty research grant of Yonsei University College of Medicine , Seoul, Korea ( 6-2019-0102 ), and Korean Endocrine Society for New Faculty Convergence Research Award 2019. The funding sources or sponsors had no involvement throughout the study.

Publisher Copyright:
© 2021

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Oncology

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jbo.2021.100409

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title = "Protective effect of bisphosphonate on the cortical bone at key locations of the femur in aromatase inhibitor-associated bone loss: A three-dimensional cortical bone mapping study",

abstract = "Aromatase inhibitor treatment in breast cancer is associated with accelerated bone loss and an increased risk of fracture. Bisphosphonates (BPs) are the mainstay treatment of aromatase inhibitor-associated bone loss (AIBL), which might improve femoral bone at key locations prone to fracture. To test this hypothesis, we performed three-dimensional cortical bone mapping based on quantitative computed tomography (QCT) scans in postmenopausal women with early breast cancer who were receiving aromatase inhibitors. Data of subjects who had both baseline and at least one follow-up QCT at Severance Hospital (South Korea) between 2005 and 2015 were analyzed (BP users, n = 93; BP non-users, n = 203). After exclusion of BP users with low medication persistence (proportion of days covered: <50%), BP users and non-users were 1:1 matched (n = 54 for each group) in terms of age, lumbar spine volumetric bone mineral density (LSvBMD), femoral neck areal BMD (FNaBMD), and total hip areal BMD (THaBMD). During a median follow-up of 2.1 years, BP use attenuated bone loss in LSvBMD (+7.2% vs. −3.8%, p < 0.001), FNaBMD (+1.3% vs. −2.7%, p < 0.001), and THaBMD (-0.3% vs. −2.5%, p = 0.024). BP had a protective effect on cortical parameters of femoral bone: estimated cortical thickness (CTh) (+3.3% vs. + 0.1%, p = 0.007) and cortical mass surface density (CMSD, cortical mass per unit surface area was calculated by multiplying cortical BMD with CTh) (+3.4% vs. −0.3%, p < 0.001). CMSD increased by up to 15% at key locations such as the superior part of the femoral neck and greater trochanter. BP prevented the thinning of average CTh of the femoral neck (-1.4% vs. −6.1%, p < 0.001), particularly at the superior anterior quadrant of femoral neck (absolute difference: +12.8% point vs. non-users). Compared to BP non-users, BP users had improved cross-sectional moment of inertia (+4.4% vs. −0.7%, p = 0.001) and less increase in buckling ratio (+1.3% vs. + 7.5%, p < 0.001). In summary, BP use prevented cortical bone deficits observed in AIBL at key locations of the proximal femur.",

author = "Namki Hong and Burm, {Seung Won} and Graham Treece and {Ye Kim}, Jee and {Hwan Kim}, Min and Seunghyun Lee and Sungjae Shin and Yumie Rhee",

note = "Funding Information: We thank Keenan Brown (Mindways Software, Inc. TX, USA) for his insightful discussion and technical support. The data analyzed in this study are available upon reasonable request to the corresponding author (YR). This work was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety, the National Research Foundation of Korea) (Project Number:1711139101, KMDF_PR_20210527_0003), the faculty research grant of Yonsei University College of Medicine, Seoul, Korea (6-2019-0102), and Korean Endocrine Society for New Faculty Convergence Research Award 2019. The funding sources or sponsors had no involvement throughout the study. This study was approved by the institutional review board of Severance Hospital, Seoul, Korea (IRB no. 4-2018-0635), with the requirement for informed consent waived due to the fact that medical records were reviewed in this study. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and the 1964 Declaration of Helsinki and its later amendments. Funding Information: This work was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety, the National Research Foundation of Korea ) (Project Number: 1711139101 , KMDF_PR_20210527_0003), the faculty research grant of Yonsei University College of Medicine , Seoul, Korea ( 6-2019-0102 ), and Korean Endocrine Society for New Faculty Convergence Research Award 2019. The funding sources or sponsors had no involvement throughout the study. Publisher Copyright: {\textcopyright} 2021",

year = "2022",

month = feb,

doi = "10.1016/j.jbo.2021.100409",

language = "English",

volume = "32",

journal = "Journal of Bone Oncology",

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T1 - Protective effect of bisphosphonate on the cortical bone at key locations of the femur in aromatase inhibitor-associated bone loss

T2 - A three-dimensional cortical bone mapping study

AU - Hong, Namki

AU - Burm, Seung Won

AU - Treece, Graham

AU - Ye Kim, Jee

AU - Hwan Kim, Min

AU - Lee, Seunghyun

AU - Shin, Sungjae

AU - Rhee, Yumie

N1 - Funding Information: We thank Keenan Brown (Mindways Software, Inc. TX, USA) for his insightful discussion and technical support. The data analyzed in this study are available upon reasonable request to the corresponding author (YR). This work was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety, the National Research Foundation of Korea) (Project Number:1711139101, KMDF_PR_20210527_0003), the faculty research grant of Yonsei University College of Medicine, Seoul, Korea (6-2019-0102), and Korean Endocrine Society for New Faculty Convergence Research Award 2019. The funding sources or sponsors had no involvement throughout the study. This study was approved by the institutional review board of Severance Hospital, Seoul, Korea (IRB no. 4-2018-0635), with the requirement for informed consent waived due to the fact that medical records were reviewed in this study. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and the 1964 Declaration of Helsinki and its later amendments. Funding Information: This work was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety, the National Research Foundation of Korea ) (Project Number: 1711139101 , KMDF_PR_20210527_0003), the faculty research grant of Yonsei University College of Medicine , Seoul, Korea ( 6-2019-0102 ), and Korean Endocrine Society for New Faculty Convergence Research Award 2019. The funding sources or sponsors had no involvement throughout the study. Publisher Copyright: © 2021

PY - 2022/2

Y1 - 2022/2

N2 - Aromatase inhibitor treatment in breast cancer is associated with accelerated bone loss and an increased risk of fracture. Bisphosphonates (BPs) are the mainstay treatment of aromatase inhibitor-associated bone loss (AIBL), which might improve femoral bone at key locations prone to fracture. To test this hypothesis, we performed three-dimensional cortical bone mapping based on quantitative computed tomography (QCT) scans in postmenopausal women with early breast cancer who were receiving aromatase inhibitors. Data of subjects who had both baseline and at least one follow-up QCT at Severance Hospital (South Korea) between 2005 and 2015 were analyzed (BP users, n = 93; BP non-users, n = 203). After exclusion of BP users with low medication persistence (proportion of days covered: <50%), BP users and non-users were 1:1 matched (n = 54 for each group) in terms of age, lumbar spine volumetric bone mineral density (LSvBMD), femoral neck areal BMD (FNaBMD), and total hip areal BMD (THaBMD). During a median follow-up of 2.1 years, BP use attenuated bone loss in LSvBMD (+7.2% vs. −3.8%, p < 0.001), FNaBMD (+1.3% vs. −2.7%, p < 0.001), and THaBMD (-0.3% vs. −2.5%, p = 0.024). BP had a protective effect on cortical parameters of femoral bone: estimated cortical thickness (CTh) (+3.3% vs. + 0.1%, p = 0.007) and cortical mass surface density (CMSD, cortical mass per unit surface area was calculated by multiplying cortical BMD with CTh) (+3.4% vs. −0.3%, p < 0.001). CMSD increased by up to 15% at key locations such as the superior part of the femoral neck and greater trochanter. BP prevented the thinning of average CTh of the femoral neck (-1.4% vs. −6.1%, p < 0.001), particularly at the superior anterior quadrant of femoral neck (absolute difference: +12.8% point vs. non-users). Compared to BP non-users, BP users had improved cross-sectional moment of inertia (+4.4% vs. −0.7%, p = 0.001) and less increase in buckling ratio (+1.3% vs. + 7.5%, p < 0.001). In summary, BP use prevented cortical bone deficits observed in AIBL at key locations of the proximal femur.

AB - Aromatase inhibitor treatment in breast cancer is associated with accelerated bone loss and an increased risk of fracture. Bisphosphonates (BPs) are the mainstay treatment of aromatase inhibitor-associated bone loss (AIBL), which might improve femoral bone at key locations prone to fracture. To test this hypothesis, we performed three-dimensional cortical bone mapping based on quantitative computed tomography (QCT) scans in postmenopausal women with early breast cancer who were receiving aromatase inhibitors. Data of subjects who had both baseline and at least one follow-up QCT at Severance Hospital (South Korea) between 2005 and 2015 were analyzed (BP users, n = 93; BP non-users, n = 203). After exclusion of BP users with low medication persistence (proportion of days covered: <50%), BP users and non-users were 1:1 matched (n = 54 for each group) in terms of age, lumbar spine volumetric bone mineral density (LSvBMD), femoral neck areal BMD (FNaBMD), and total hip areal BMD (THaBMD). During a median follow-up of 2.1 years, BP use attenuated bone loss in LSvBMD (+7.2% vs. −3.8%, p < 0.001), FNaBMD (+1.3% vs. −2.7%, p < 0.001), and THaBMD (-0.3% vs. −2.5%, p = 0.024). BP had a protective effect on cortical parameters of femoral bone: estimated cortical thickness (CTh) (+3.3% vs. + 0.1%, p = 0.007) and cortical mass surface density (CMSD, cortical mass per unit surface area was calculated by multiplying cortical BMD with CTh) (+3.4% vs. −0.3%, p < 0.001). CMSD increased by up to 15% at key locations such as the superior part of the femoral neck and greater trochanter. BP prevented the thinning of average CTh of the femoral neck (-1.4% vs. −6.1%, p < 0.001), particularly at the superior anterior quadrant of femoral neck (absolute difference: +12.8% point vs. non-users). Compared to BP non-users, BP users had improved cross-sectional moment of inertia (+4.4% vs. −0.7%, p = 0.001) and less increase in buckling ratio (+1.3% vs. + 7.5%, p < 0.001). In summary, BP use prevented cortical bone deficits observed in AIBL at key locations of the proximal femur.

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Protective effect of bisphosphonate on the cortical bone at key locations of the femur in aromatase inhibitor-associated bone loss: A three-dimensional cortical bone mapping study

Abstract

Bibliographical note

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