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Adverse effects of tamoxifen treatment on bone mineral density in premenopausal patients with breast cancer: a systematic review and meta-analysis

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Abstract

Background

It is well known that adjuvant tamoxifen treatment for breast cancer in postmenopausal women decreased bone loss. However, the effects of adjuvant tamoxifen therapy on bone mineral density (BMD) in premenopausal patients with breast cancer remains uncertain. Tamoxifen would have a potential impact of premenopausal BMD on health. The aim of this meta-analysis was to assess this in premenopausal women with primary breast cancer.

Methods

Through April 2020, studies reporting BMD changes of lumbar spine or hip in premenopausal women with primary breast cancer treated with adjuvant tamoxifen and tamoxifen plus chemotherapy or ovarian function suppression (OFS) were collected from EMBASE and PubMed. The meta-analysis was performed using random effects model of the standardized mean difference (SMD) of BMD in patients.

Results

A total of 1432 premenopausal patients were enrolled in eight studies, involving 198 patients treated with tamoxifen alone in three studies. After a 3-year median follow-up, adjuvant tamoxifen decreased the lumbar spinal and hip BMD by as much as an SMD of −1.17 [95% confidence interval (CI); −1.58 to −0.76)] and −0.66 (95% CI, −1.55 to 0.23), respectively. In subgroup analysis in patients treated adjuvant tamoxifen and tamoxifen plus chemotherapy or OFS according to follow-up duration, the bone change of < 3 years follow-up group was −0.03 SMD (95% CI, −0.47 to 0.41) and that of ≥ 3 years follow-up group was −1.06 SMD (95% CI, −1.48 to −0.64). Compared with patients who received tamoxifen alone, patients who received combination therapy with chemotherapy or OFS showed lesser bone loss at the lumbar spine.

Conclusions

Our meta-analysis demonstrated that adjuvant tamoxifen therapy in premenopausal patients caused bone loss after 3 years of follow-up, especially at the lumbar spines. For a definite evaluation of the adverse effects of tamoxifen on bone, it is necessary to accumulate more relevant studies.

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Availability of data and materials

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

BMD:

Bone mineral density

CI:

Confidence interval

OFS:

Ovarian function suppression

SMD:

Standardized mean difference

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Acknowledgements

We would like to thank Editage (www.editage.co.kr) for English language editing.

Funding

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Author notes

  1. Soo Jin Lee and Chihwan David Cha equally contributed as first authors.

Authors and Affiliations

  1. Department of Nuclear Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, South Korea

    Soo Jin Lee & Yun Young Choi

  2. Department of Surgery, Hanyang University Medical Center, Hanyang University College of Medicine, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, South Korea

    Chihwan David Cha & Min Sung Chung

  3. Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, 222 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, South Korea

    Hanpyo Hong

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Contributions

Study concept and design: CDC, SJL, MSC. Data acquisition: CDC, YYC. Quality control of data: CDC, SJL. Data analysis and interpretation: CDC, SJL, HH. Drafting of the manuscript: CDC, SJL, YYC, HH. Revision of the manuscript for important intellectual content: All authors. Manuscript review: MSC. Study supervision: MSC.

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Correspondence to Min Sung Chung.

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Lee, S.J., Cha, C.D., Hong, H. et al. Adverse effects of tamoxifen treatment on bone mineral density in premenopausal patients with breast cancer: a systematic review and meta-analysis. Breast Cancer (2024). https://doi.org/10.1007/s12282-024-01586-2

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