AUTHOR=Shin Eunju , Kim Seung Il , Park Min-ho , Kim Hyun-Ah , Jung Yongsik , Ryu Jai Min , Park Eun Hwa , Kim Sung Yong , Lee Eun-Gyeong , Lee Min Hyuk , Park Jung Ho , Im Seock-Ah , Bae Soong June , Kang Su Hwan , Lim Woo Sung , Youn Hyun Jo , Park Heung Kyu , Park Kyong Hwa , Kim Tae Hyun , Park Shin Young , Lim Cheol Wan , Kwak Geum Hee , Park Chanheun , Shin Hyuk Jae , Yoo Young Bum , Kang Sun Hee , Kim Bong Kyun , Kim Hee Jeong 

TITLE=Comparative study on bone mineral density in premenopausal patients with estrogen receptor-positive breast cancer in ASTRRA Study: a 5-year follow-up study

JOURNAL=Frontiers in Oncology

VOLUME=Volume 15 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2025.1465256

DOI=10.3389/fonc.2025.1465256

ISSN=2234-943X

ABSTRACT=PurposeWe compared the impact of tamoxifen alone or with ovarian function suppression (OFS) on bone mineral density (BMD) in premenopausal patients after chemotherapy.MethodsOf 1483 premenopausal women enrolled in the ASTRRA study, we included 522 who underwent BMD examinations at diagnosis and 3 and 5 years after diagnosis. All BMD measurements were performed using the same scanner in each center across different time points. Patients were stratified into three groups: within the expected range for age (A, Z-score>-1.0), below the expected range (B,-2.0≤ Z-score ≤-1.0), and low bone mineral density for chronological age (C, Z-score< -2.0) groups. We examined changes in groups from baseline to >3-year and 5-year periods to identify any deterioration in BMD. We conducted a subset analysis using the Asan Medical Center (AMC; n=141) data, focusing on the absolute value of bone density (in g/cm2 unit).ResultsThe 522 included patients (median age, 41.1 years) had a higher bone loss incidence in the OFS addition group at baseline (p=0.028). The tamoxifen-only and tamoxifen+OFS groups did not differ significantly in terms of changes in BMD categories from baseline to 3 (p=0.567) or 5 years (p=0.600). The OFS addition group had a significantly increased risk of BMD deterioration when randomized at the first visit (odds ratio=2.970, p=0.008). Within the AMC subset, the OFS addition group exhibited significantly decreased BMD in the spine (p=0.023) and femur (p=0.040) from the baseline to 3-year period. A non-significantly decreased BMD occurred from the baseline to 5 years in the spine and femur.ConclusionOur findings highlighted the deleterious impact on BMD following OFS addition, compared with tamoxifen only treatment. Early OFS exerted an even more detrimental influence on bone health in premenopausal patients with estrogen receptor-positive breast cancer and recovered ovarian function.AbbreviationsANOVA, analysis of variance; BMD, one mineral density; CTIBL, Cancer treatment-induced bone loss; DXA, dual-energy X-ray absorptiometry; HER2 human epidermal growth factor receptor 2; L-spin, lumbar spine; OFS, ovarian function suppression; TAM, tamoxifen.