Exemestane Worsens Bone Loss in Postmenopausal Women
February 7, 2012
Exemestane (Aromasin) may cause substantial bone loss, according to a study published in Lancet Oncology. The aromatase inhibitor, which has been suggested to reduce the risk of getting breast cancer, may in fact pose significant harm to bone health in postmenopausal women.
To examine the safety of exemestane on bone health, Dr. Angela Cheung and colleagues conducted a nested safety substudy within the Mammary Prevention 3 (MAP.3) trial. MAP.3 is a randomized, placebo-controlled, double-blind trial of exemestane 25 mg a day for the primary prevention of breast cancer in healthy, postmenopausal women considered at "high risk" for the disease. In this substudy, 176 women (median age of 61.3 years) were given exemestane and 175 were assigned to placebo. The primary endpoint was percent change from baseline to 2 years in total volumetric bone mineral density (BMD) at the distal radius (wrist) by high-resolution peripheral quantitative CT. Normal, age-related bone loss was expected in all women. At the time of the analysis, 242 women had completed the 2-year follow-up: 124 and 118 in the exemestane and placebo groups, respectively.
After two years of follow-up, the mean percent change in total volumetric BMD at the distal radius was −6.1% in the exemestane group and −1.8% in the placebo group. The results also suggested large and significant decreases in total volumetric BMD at the distal tibia (-5.0% versus -1.3%). "Women considering exemestane for the primary prevention of breast cancer should weigh their individual risks and benefits. For women taking exemestane, regular bone monitoring plus adequate calcium and vitamin D supplementation are important," conclude the authors.
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