Breast cancer outcome in relation to bone mineral density and bisphosphonate use: a sub-study of the DATA trial

Irene E. G. van Hellemond, Carolien H. Smorenburg, Petronella G. M. Peer, Astrid C. P. Swinkels, Caroline M. Seynaeve, Maurice J. C. van der Sangen, Judith R. Kroep, Hiltje de Graaf, Aafke H. Honkoop, Frans L. G. Erdkamp, Franchette W. P. J. van den Berkmortel, Wilfred K. de Roos, Sabine C. Linn, Alexander L. T. Imholz, Maaike de Boer, Vivianne C. G. Tjan-Heijnen*, Dutch Breast Canc Res Grp BOOG

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Purpose The phase III DATA study compared 6 and 3 years of adjuvant anastrozole following 2-3 years of tamoxifen in postmenopausal breast cancer patients. This pre-planned side-study assessed the relationship between a reduced bone mineral density (BMD) and distant recurrence-free survival (DRFS), and evaluated the effect of bisphosphonates on DRFS. Methods We selected all patients with a BMD measurement within 3 years after randomisation (landmark) without any DRFS events. Kaplan-Meier methods and Cox proportional hazards models were used for analyses. Results Of 1860 eligible patients, 1142 had a DEXA scan before the landmark. The BMD was normal in 436 (38.2%) and showed osteopenia in 565 (49.5%) and osteoporosis in 141 (12.3%) patients. After a median follow-up of 5.0 years from the landmark, neither osteopenia nor osteoporosis (compared with normal BMD) were associated with DRFS in both the 6-year [osteopenia HR 0.82 (95% CI 0.45-1.49), osteoporosis HR 1.10 (95% CI 0.26-4.67)] and the 3-year arm [osteopenia HR 0.75 (95% CI 0.40-1.42), osteoporosis HR 1.86 (95% CI 0.43-8.01)]. Moreover, bisphosphonate use did not impact DRFS. Conclusion No association was observed between a reduced BMD and DRFS. Neither did we observe an impact of bisphosphonates on DRFS.

Original languageEnglish
Pages (from-to)675-685
Number of pages11
JournalBreast Cancer Research and Treatment
Issue number3
Publication statusPublished - Apr 2020


  • Breast cancer
  • Tamoxifen
  • Aromatase inhibitor
  • Bone health
  • Osteoporosis
  • Bisphosphonates
  • Survival
  • Bone metastases
  • Distant recurrence-free survival
  • RISK

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