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TBS plays a significant role in breast cancer patient management

TBS plays a significant role in breast cancer patient management

How is bone health related to breast cancer?

Some breast cancer treatments, such as aromatase inhibitors, can increase the risk of secondary osteoporosis which may not be detected at an early stage by BMD and FRAX alone. The addition of TBS alongside BMD and FRAX, ensures that more patients at risk are detected in a timely manner.

Aromatase inhibitors are used primarily for the treatment of postmenopausal women with hormone-receptor-positive breast cancer. They work by blocking the enzyme aromatase, which is responsible for converting androgens to estrogens in many parts of the body. By inhibiting this conversion, aromatase inhibitors reduce estrogen levels thereby slowing the growth of certain breast tumors and/or reducing the risk of breast cancer recurrence. However, at the same time, these treatments can affect bone, leading to increased fracture risk.

Given the effects of aromatase inhibitors on bone health, assessing both bone density (using BMD) and bone quality (using TBS) can provide a more complete understanding of fracture risk in women with breast cancer who are treated with aromatase inhibitors.

Evidence indicates that women on aromatase inhibitors can experience changes in bone microarchitecture (reflected by TBS) often before significant changes in BMD are observed. This suggests that TBS might be an early indicator of bone health deterioration in this population. Observed reductions in TBS with aromatase treatment have been shown to be independent of BMD (Pedrazzoni 2014, Mariotti 2017, Hong 2017), and FRAX (Mariotti 2017).

Incorporating TBS evaluations in the routine monitoring of women treated with aromatase inhibitors might help in the early identification of those at an increased risk for fractures, allowing for timely interventions such as treatment with anti-osteoporosis medication.

A recent study by Antoni et al., (2023) showed that denosumab can significantly improve TBS and reduce fracture risk in women receiving treatment for breast cancer with aromatase inhibitors.

Learn how TBS can be seamlessly integrated in your clinical workflow with a step-by-step guide based on the position paper from the IOF/ESCEO expert working group supported by the WHO*:

Download the Practical Guide to TBS in Clinical Routine now:

This guide includes 22 evidence-based recommendations strongly endorsed according to GRADE** methodology underscoring the significance of Trabecular Bone Score (TBS). This study highlights the value of assessing TBS in this scenario given that use of aromatase inhibitors is associated with secondary osteoporosis.


*European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Disease (ESCEO) and the International Osteoporosis Foundation (IOF) under the auspices of WHO Collaborating Centre for Epidemiology of Musculoskeletal Health and Aging

**Grades of Recommendation, Assessment, Development and Evaluation approach used by the ESCEO-IOF International Expert working group

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