The role of vitamin D in the treatment of secondary osteoporosis in cancer patients


Authors: Špániková Beata 1;  Špánik Stanislav 2
Authors‘ workplace: Osteocentrum pre vybrané onkologické diagnózy LF UK a Onkologický ústav sv. Alžbety, s. r. o., Bratislava 1;  I. onkologická klinika LF UK, Bratislava 2
Published in: Clinical Osteology 2018; 23(4): 169-175
Category:

Overview

D vitamin plays an important role in the metabolism of calcium and bone metabolism. In addition, it appears that those with lower vitamin D levels have higher incidence of cancer, especially breast, prostate, and colon carcinoma. Breast cancer is the most common malignant disease in women. For postmenopausal patients with positive hormone receptors, hormonal therapy with aromatase inhibitors is often used at various stages. This improves the prognosis of patients, their survival, and reduces the occurrence of distant metastases, but also has side effects in particular on musculoskeletal system. In addition to secondary osteoporosis, arthralgia and myalgia occur. Sufficient vitamin D supplementation can alleviate them. In our prospective study, we monitored vitamin D levels in 100 postmenopausal patients with newly diagnosed hormone positive breast cancer who were indicated for treatment with aromatase inhibitors. Their bone density was examined. We evaluated the comparison of the lowest T scores and their difference in the initial examination and after the year of treatment with aromatase inhibitors. We only included those with bone density at the level of osteopenia or normal level. We recommended a calcium substitution of about 1000 mg per day and 1000 IU of vitamin D for all patients. We checked the bone mineral density and the levels of Ca and D vitamin after one year of follow-up. Initially insufficient vitamin D levels were present in 85% of patients. After substitution the number of patients with a sufficient level of vitamin D increased from 14% to 48%. Still 52% of patients with insufficient vitamin D levels remained. Despite the recommendation of substitution of the combination of Ca and vitamin D, only 27% after the year accepted these recommendations, 38% used only D vitamin, 4% only calcium and up to 31% remained without treatment. The results of our study show that D vitamin can be use-full in stabilization of bone density in risky breast cancer patients on aromatase inhibitors therapy. Unfortunately, there is insufficient compliance of both patients and doctors to preventive bone loss measures in this group of patients.

Keywords:

aromatase inhibitors – breast cancer – calcium – compliance – substitution – vitamin D


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