[3]The large Arimidex, Tamoxifen Alone or in Combination (ATAC) study compared anastrozole, tamoxifen, and the combination of both drugs as first-line adjuvant therapy in over 9,000 women. Improved survival is due in part to the successful use of adjuvant hormonal therapies in estrogen and/or progesterone receptor-positive disease. Studies of AIs in the neoadjuvant and prevention settings are limited to date and several trials are ongoing.
Heshmati HM, Khosla S, Robins SP, et al: Role of low levels of endogenous estrogen in regulation of bone resorption in late postmenopausal women. If you lose your appetite, it … II. It should be remembered that, in contrast to the AIs, the SERMs tamoxifen and raloxifene (Evista) have a protective effect on bone health in postmenopausal women.
[14] As expected, at the 3-year analysis anastrozole/goserelin induced the most severe bone effects (17% lower BMD, relative T score of -1.6). Tamoxifen may help reduce the risk of new cancer growth, shrink tumors, help prevent bone loss and lower cholesterol levels. There are lots of good resources out there. During your childhood and teenage years, your body adds new bone faster than it gets rid of old bone. [48]Other safety concerns became apparent after approval of bisphosphonates.
It was most effective in subjects who were most compliant, and especially women of lighter weight. Intravenous bisphosphonates such as zoledronic acid are also generally well tolerated, although infusion may be associated with fever and a flu-like syndrome consisting of fever, chills, bone pain and/or arthralgias, and myalgias.
[51] These include a complete dental examination with preventative dentistry before initiating IV bisphosphonates, avoiding invasive dental procedures whenever possible, and maintaining excellent oral hygiene.
Several studies have compared various aromatase inhibitors to Tamoxifen.
[51,53] Physicians should be alert to the early symptoms of ONJ, which include changes in periodontal and mucosal tissues, soft-tissue infection or swelling, oral mucosal lesions that fail to heal, oral or jaw pain or numbness, and loose teeth. This trial included self-reported fracture as a predefined endpoint.
Among anastrozole-treated patients, there was a decrease in median BMD from baseline to 5 years in lumbar spine (−6.08%) and total hip (−7.24%) compared with the tamoxifen group (lumbar spine, +2.77%; total hip, +0.74%). Benito M, Gomberg B, Wehrli FW, et al: Deterioration of trabecular architecture in hypogonadal men. Bone quality is increasingly recognized as an important determinant of overall bone health, and studies have shown that substantial deterioration of bone microarchitecture can occur before bone density is affected.
Aromatase inhibitors are likely to replace SERMs as first-line adjuvant therapy for many patients. The pain from Arimidex was almost exclusively in my feet, and usually constant, even waking me from sleep. In contrast, hormone therapy can reduce the risk of these late recurrences, and the decreased risk lasts even after the medication has been discontinued.
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