Innegligible musculoskeletal disorders caused by zoledronic acid in adjuvant breast cancer treatment: a meta-analysis
Open Access
- 4 August 2011
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of Experimental & Clinical Cancer Research
- Vol. 30 (1), 72-7
- https://doi.org/10.1186/1756-9966-30-72
Abstract
Background Zoledronic acid (ZOL) is widely used for preventing bone loss in early breast cancer patients. However, the adverse effects caused by ZOL itself should not be neglected. Musculoskeletal disorders were common after ZOL administration and distressing to the patients. Up to now, no precise estimation of musculoskeletal disorders has been made. Methods Relevant randomized clinical trials were selected by searching the electronic database PubMed, and a meta-analysis was conducted. Results Four trials reported musculoskeletal disorders of ZOL treatment versus no ZOL, including 2684 patients treated with ZOL and 2712 patients without ZOL treatment. Compared to patients without ZOL treatment, patients treated with ZOL had a significantly higher risk of arthralgia (risk ratio (RR): 1.162, 95% confidence interval (CI): 1.096-1.232, P = 0.466 for heterogeneity) and bone pain (RR: 1.257, 95% CI: 1.149-1.376, P = 0.193 for heterogeneity). Three clinical trials reported the complications of upfront versus delayed ZOL treatment, including 1091 patients with upfront ZOL and 1110 patients with delayed ZOL. The rate of bone pain in upfront group (119/824) was significantly higher than that in delayed group (74/836) (RR: 1.284, 95% CI: 1.135-1.453, P = 0.460 for heterogeneity). Conclusions Our meta-analysis suggested that treatment with ZOL was significantly associated to the occurrence of arthralgia and bone pain. Moreover, higher rate of bone pain was observed in patients treated with upfront ZOL compared with delayed ZOL treatment. More attentions should be paid to patients treated with ZOL, especially for immediate ZOL. For patients with low risk of osteoporosis, immediate ZOL may be not needed due to additional musculoskeletal disorders and little benefit. Or it can be stopped after the occurrence of these adverse events.Keywords
This publication has 33 references indexed in Scilit:
- The Efficacy of Bisphosphonates in the Prevention of Vertebral, Hip, and Nonvertebral-Nonhip Fractures in Osteoporosis: A Network Meta-AnalysisSeminars in Arthritis and Rheumatism, 2011
- Incidence of chemotherapy-induced amenorrhea associated with epirubicin, docetaxel and navelbine in younger breast cancer patientsBMC Cancer, 2010
- Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trialThe Lancet Oncology, 2008
- Five Years of Letrozole Compared With Tamoxifen As Initial Adjuvant Therapy for Postmenopausal Women With Endocrine-Responsive Early Breast Cancer: Update of Study BIG 1-98Journal of Clinical Oncology, 2007
- Pamidronate in the Prevention of Chemotherapy-Induced Bone Loss in Premenopausal Women with Breast Cancer: A Randomized Controlled TrialJournal of Clinical Endocrinology & Metabolism, 2005
- Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trialsThe Lancet, 2005
- Screening for Breast CancerJAMA, 2005
- Incidence of chemotherapy-induced amenorrhea depending on the timing of treatment by menstrual cycle phase in women with early breast cancerAnnals of Oncology, 2004
- Aromatase and Its Inhibitors: Significance for Breast Cancer TherapyProceedings of the 1972 Laurentian Hormone Conference, 2002
- Ovarian Failure After Adjuvant Chemotherapy Is Associated With Rapid Bone Loss in Women With Early-Stage Breast CancerJournal of Clinical Oncology, 2001