The role of vitamin D in the treatment of secondary osteoporosis in cancer patients
Špániková Beata 1; Špánik Stanislav 2
Osteocentrum pre vybrané onkologické diagnózy LF UK a Onkologický ústav sv. Alžbety, s. r. o., Bratislava
1; I. onkologická klinika LF UK, Bratislava
Clinical Osteology 2018; 23(4): 169-175
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.
aromatase inhibitors – compliance – substitution
- Ness RA, Duane D, Miller DD et al. The role of vitamin D in cancer prevention Department of Pharmaceutical Sciences, University of Tennessee Health Sciences Center, Memphis TN 38163, USA. Chinese Journal of Natural Medicines 2015, 13(7): 481–497. Dostupné z DOI: <http://doi.org/10.1016/S1875–5364(15)30043–1>.
- Vieth R, Bischoff-Ferrari H, Boucher BJ et al. The urgent need to reccomend and intake of vitamin D that is effective. Am J Clin Nutr 2007; 85(3): 649–650. Dostupné z DOI: <http://dx.doi.org/10.1093/ajcn/85.3.649>. Erratum in Am J Clin Nutr 2007; 86(3): 809.
- Feldman D, Kishnan AV, Swami S et al. The role of vitamin D in reducing cancer risk and progression. Nat Rev Cancer 2014; 14(5): 342–357. Dostupné z DOI: <http://dx.doi.org/10.1038/nrc3691>.
- Krishnan AV, Swami S, Feldman D. Vitamin D and breast cancer: Inhibition of estrogen and synthesis and signaling. J Steroid Biochem Mol Biol 121; 2010(1–2): 343–348. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jsbmb.2010.02.009>.
- Krajewski W, Dziegala M, Dembowski J et al. Vitamin D and urological cancers. Cent. European J Urol 2016; 69(2): 139–147. Dostupné z DOI: <http://dx.doi.org/10.5173/ceju.2016.784>.
- Vani SA, Ananthanarayanan PH, Nandeesha H et al. Effects of vitamin D and calcium supplementation on side effects profile in patients of breast cancer treated with letrozole. Clin Chim Acta 2016; 459: 53–56. Dostupné z DOI: <http://dx.doi.org/10.1016/j.cca.2016.05.020>.
- Jakesz R, Jonat W, Gnant M et al: Switching of postmenopausal women with endocrine-responsive early beast cancer to anastrozole after two years adjuvant tamoxifen: Combine results of ABCSG trial 8 and ARNO 95 trial. Lancet 2005; 366(9484): 455–462. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(05)67059–6>.
- Howell A, Cuzick J, Baum M et al. Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years‘ adjuvant treatment for breast cancer. Lancet 2005; 365(9453): 60–62. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(04)17666–6>.
- Forbes JF, Cusick J, Buzdar A et al. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol 2008; 9(1): 45–53. Dostupné z DOI: <http://dx.doi.org/10.1016/S1470–2045(07)70385–6>.
- Coleman RE. Effect of anastrozole on bone mineral density: 5-year results from the ’Arimidex’, Tamoxifen, Alone or in Combination (ATAC) trial. J Clin Oncol 2006; 24(18 Suppl): S511. Dostupné z DOI: <http://dx.doi.org/10.1200/jco.2006.24.18_suppl.511>.
- Thürlimann B, Keshaviah A, Coates AS et al. [Breast International Group (BIG) 1–98 Collaborative Group]. A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. N Engl J Med 2005; 353(26), 2747–2757. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa052258>. Erratum in N Engl J Med 2006; 354(20): 2200. Wardly, Andrew [corrected to Wardley, Andrew].
- Kim HJ, Lee YM, Ko BS et al. Vitamin D Deficiency is Corelated with Poor Outcomes in Patients with Luminal-type Breast cancer. Ann Surg Oncol 2011; 18(7): 1830–1836. Dostupné z DOI: <http://dx.doi.org/10.1245/s10434–010–1465–6>.
- Servitja S, Nogues X, Alhambra DP et al. Bone health in a prospective cohort of postmenopausal women recieving aromatase inhibitors for early breast cancer. Breast 2012; 21(1): 95–101. Dostupné z DOI: <http://dx.doi.org/10.1016/j.breast.2011.09.001>.
- Špánik S, Špániková B. Bone mineral density in early breast cancer patients. Bratisl Lek Listy 2010; 111(1): 27–32
- Boškovic L, Gašparic M, Petkovic M et al. Bone health and adherence to vitamin D and calcium therapy in erly breast cancer patients on endocrine therapy with aromatase inhibitors. Breast 2017; 31: 16–19. Dostupné z DOI: <http://dx.doi.org/10.1016/j.breast.2016.10.018>.
- Shin MH, Holmes MD, Hankinson SE et al. Intake diary products, calcium and d vitamin and risk of breast cancer. J Nat Cancer Inst 2002; 94(17): 1301–1311.
- Body JJ, Bergmann P, Boonen S et al. Extraskeletal benefits and risks of calcium, vitamin D and anti-osteoporosis medications. Osteoporosis Int 2012; 23(Suppl): S1-S23. Dostupné z DOI: <http://dx.doi.org://10.1007/s00198–011–1891–8>.
Gynaecology and obstetrics
General practitioner for adults