Meta-analysis: does zoledronic acid prevent bone loss in early breast cancer?

  • Mei M & al.
  • Curr Probl Cancer
  • 1 Nov 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • A meta-analysis finds that zoledronic acid (ZA) prevents bone loss in patients with early breast cancer (eBCa) but there is some variation by bone site and by menopausal status.

Why this matters

  • Adjuvant therapy drugs for breast cancer, such as endocrine therapy, cause bone loss and therefore place patients at risk for fracture.

Study design

  • Meta-analysis of 13 randomized controlled trials (RCTs) with 7375 participants after search of PubMed, EMBASE, and Cochrane database.
  • Treatment duration of ZA ranged from 1 to 5 years; treatment efficacy was evaluated by bone mineral density (BMD).
  • Funding: National Natural Science Foundation of China; the Beijing Natural Science Foundation.

Key results

  • In a mixed population (pre- and postmenopausal patients), ZA increased BMD at all 3 bone sites vs no ZA:
    • Lumbar spine (LS; mean difference [MD], 0.06 g/cm2; P=.00001).
    • Total hip (TH; MD, 0.03 g/cm2; P=.00001).
    • Femoral neck (FN; MD, 0.03 g/cm2; P=.01).
  • In the premenopausal subgroup, ZA (vs no ZA) increased BMD at 1 site:
    • LS (MD, 0.06 [95% CI, 0.05-0.08] g/cm2).
    • TH (no difference).
    • FN (no difference).
  • In the postmenopausal subgroup, ZA (vs no ZA) increased BMD at 2 sites:
    • LS (MD, 0.06 [95% CI, 0.05-0.07] g/cm2).
    • TH  (MD, 0.04 [95% CI, 0.03-0.04] g/cm2).
    • FN (no difference).

Limitations

  • Heterogeneity across studies.

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