In a groundbreaking cohort study involving 237 postmenopausal women with breast cancer undergoing adjuvant therapy, researchers have uncovered a surprising association between fat body mass (FBM) and vertebral fracture progression. The study, conducted at the Breast Unit of ASST Spedali Civili of Brescia from September 2014 to June 2018, focused on patients receiving aromatase inhibitors (AIs) and denosumab.
Key findings from the study:
- Association with Fat Body Mass: Patients with higher baseline fat body mass, exceeding the median, were independently associated with vertebral fracture progression after 18 months of adjuvant therapy with aromatase inhibitors and denosumab.
- Fracture Risk Assessment Tool (FRAX): The Fracture Risk Assessment Tool score for major fractures was also identified as an independent risk factor for vertebral fracture progression.
- Denosumab’s Role: Despite the protective role of denosumab, the study suggests that fat body mass may contribute to skeletal fragility in postmenopausal women undergoing adjuvant aromatase inhibitors.
The study challenges existing guidelines that consider higher body mass index (BMI) as a protective factor for bone health in postmenopausal women undergoing AI treatment. The research team suggests that the reduction in bone mineral density due to estrogen deprivation, coupled with the negative impact of adiposity on bone quality, increases the risk of bone fragility fractures during AI treatment.
The lead researcher commented, “This observation is new and indicates that diet and exercise may synergize with denosumab in the management of bone health in this patient setting.”
While the study sheds light on the complex relationship between body composition and bone health in breast cancer patients, further validation and exploration in larger patient populations are warranted. The findings may have implications for the development of personalized strategies to mitigate bone fragility risk in women undergoing adjuvant aromatase inhibitor therapy.