Assessment of the role of vitamin D with or without bone-modulating therapy in non-metastatic breast cancer patients receiving adjuvant non-steroidal aromatase inhibitors
Keywords:
Vitamin D, Bone Modulating Therapy, Non-Metastatic, Breast Cancer Patiens, Adjuvant Non-Steroidal Aromatase InhibitorsAbstract
Background: Breast cancer (BC) is classified into luminal A, luminal B, Human epidermal growth factor 2 receptors positive, and triple-negative subtypes, with adjuvant endocrine therapy recommended for hormone receptor-positive disease. This study aimed to evaluate whether vitamin D and bone-modifying therapy improve quality of life in patients with non-metastatic luminal breast cancer receiving non-steroidal Aromatase Inhibitors (NSAI) and whether these improvements are associated with better overall and disease-free survival. Methods: This prospective study was executed on 100 female participants identified with postmenopausal non metastatic (M0) luminal BC, were randomly placed into two equal groups: Group A: treated with adjuvant NSAI plus vitamin D supplementation with bone antiresorptive agents and group B: treated with adjuvant NSAI plus vitamin D supplementation without bone antiresorptive agents. Results: The mean physical well-being scores were 23.86, 25.17, and 25.8 in group A and 21.7, 22.6, and 22.91 in group B, as listed, with a significant p-value. The mean functional well-being (FWB) scores were 23.66, 25.25, and 25.98 in group A relative to 21.44, 22.93, and 23.23 in group B (P<0.05). Conclusions: Vitamin D normalization and bone-modifying agents help preserve bone health and prevent bone loss in postmenopausal women with luminal BC receiving adjuvant NSAIs.
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Al Maqbali, M., Hughes, C., Gracey, J., Rankin, J., Hacker, E., & Dunwoody, L. (2020). Psychometric Properties of the Arabic Version of the Functional Assessment of Chronic Illnesses Therapy-Fatigue in Arabic Cancer Patients. J Pain Symptom Manage, 59(1), 130-138. doi:10.1016/j.jpainsymman.2019.10.008 DOI: https://doi.org/10.1016/j.jpainsymman.2019.10.008
Ana Cláudia Araújo Santana, Daiane Costa dos Santos, & Egea, M. B. ( 2024). Nutritional Screening Tools in Institutionalized People: A Case Study of Using Nutritional Risk Screening (NRS 2002) and Mini Nutritional Assessment (MNA). Food and Nutr Sci, 7(3), 3-33. doi:10.4236/fns.2024.157037 DOI: https://doi.org/10.4236/fns.2024.157037
Azim, H. A., Elghazawy, H., Ghazy, R. M., Abdelaziz, A. H., Abdelsalam, M., Elzorkany, A., & Kassem, L. (2023). Clinicopathologic Features of Breast Cancer in Egypt-Contemporary Profile and Future Needs: A Systematic Review and Meta-Analysis. JCO Glob Oncol, 9(8), 6-66. doi:10.1200/go.22.00387 DOI: https://doi.org/10.1200/GO.22.00387
Berger, M. M., Shenkin, A., Schweinlin, A., Amrein, K., Augsburger, M., Biesalski, H. K., . . . Cuerda, C. (2022). ESPEN micronutrient guideline. Clin Nutr, 41(6), 1357-1424. doi:10.1016/j.clnu.2022.02.015 DOI: https://doi.org/10.1016/j.clnu.2022.02.015
Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R. L., Soerjomataram, I., & Jemal, A. (2024). Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 74(3), 229-263. doi:10.3322/caac.21834 DOI: https://doi.org/10.3322/caac.21834
Coleman, R., Finkelstein, D. M., Barrios, C., Martin, M., Iwata, H., Hegg, R., . . . Chan, A. (2020). Adjuvant denosumab in early breast cancer (D-CARE): an international, multicentre, randomised, controlled, phase 3 trial. Lancet Oncol, 21(1), 60-72. doi:10.1016/s1470-2045(19)30687-4 DOI: https://doi.org/10.1016/S1470-2045(19)30687-4
Cross, T., George, A., Attwood, K., Zhang, Y., O'Connor, T. L., Barone, N., . . . Hong, C. C. (2022). Associations between Serum 25-Hydroxyvitamin D Levels and Health-Related Quality-of-Life Measures in Patients with Breast Cancer: A Longitudinal Study. Cancer Epidemiol Biomarkers Prev, 31(12), 2126-2135. doi:10.1158/1055-9965.Epi-22-0343 DOI: https://doi.org/10.1158/1055-9965.EPI-22-0343
de Sire, A., Gallelli, L., Marotta, N., Lippi, L., Fusco, N., Calafiore, D., . . . Invernizzi, M. (2022). Vitamin D Deficiency in Women with Breast Cancer: A Correlation with Osteoporosis? A Machine Learning Approach with Multiple Factor Analysis. Nutrients, 14(8), 4-44. doi:10.3390/nu14081586 DOI: https://doi.org/10.3390/nu14081586
Gnant, M., Frantal, S., Pfeiler, G., Steger, G. G., Egle, D., Greil, R., . . . Singer, C. (2022). Long-Term Outcomes of Adjuvant Denosumab in Breast Cancer. NEJM Evid, 1(12), 6-66. doi:10.1056/EVIDoa2200162 DOI: https://doi.org/10.1056/EVIDoa2200162
İşbilen, E., Kus, T., Yeşil, H., Aktas, G., & Buyukbebeci, A. (2021). Better survival associated with successful vitamin D supplementation in non- metastatic breast cancer survivors. Türk Biyokimya Dergisi, 46(4), 2471-2488. doi:10.1515/tjb-2021-0137 DOI: https://doi.org/10.1515/tjb-2021-0137
Kaur, A., & Rayi, A. (2024). Eastern Cooperative Oncology Group Performance Status. StatPearls(6), 6-55.
Kuba, S., Chiba, K., Watanabe, K., Matsumoto, M., Morita, M., Akashi, M., . . . Eguchi, S. (2025). Aromatase inhibitors, bone microstructure, and estimated bone strength in postmenopausal women with breast cancer: a 5-year prospective study. J Bone Miner Metab, 43(2), 133-140. doi:10.1007/s00774-024-01560-0 DOI: https://doi.org/10.1007/s00774-024-01560-0
Liu, P. H., Tsai, C. F., Hsu, Y. C., Wu, C. Y., & Yang, H. Y. (2025). Aromatase inhibitors therapy and major osteoporotic fracture risk in postmenopausal breast cancer patients: a nationwide real-world cohort study. Breast Cancer Res, 27(1), 95-99. doi:10.1186/s13058-025-02050-5 DOI: https://doi.org/10.1186/s13058-025-02050-5
Long, Z., Qiu, Y., Long, Z., & Jin, Z. (2025). Epidemiology of breast cancer in Chinese women from 1990 to 2021: a systematic analysis and comparison with the global burden. BMC Cancer, 25(1), 3-8. doi:10.1186/s12885-024-13336-w DOI: https://doi.org/10.1186/s12885-024-13336-w
Onuma, E., Saito, S., Tsuburai, T., Yoshikata, H., Adachi, S., Yamamoto, S., . . . Asano, R. (2024). Effect of bisphosphonate and denosumab treatment on TBS in Japanese breast cancer patients with AIBL. J Bone Miner Metab, 42(6), 699-709. doi:10.1007/s00774-024-01542-2 DOI: https://doi.org/10.1007/s00774-024-01542-2
Ou, L., Lei, R., Wu, W., Guo, Y., & Huang, R. (2024). Effects of bisphosphonates combined with calcitriol in treating osteoporosis induced by endocrine therapy for breast cancer. Am J Transl Res, 16(10), 5684-5691. doi:10.62347/uoxa2126 DOI: https://doi.org/10.62347/UOXA2126
SG, H. D. W. W. J. (2003). Applied statistics for the behavioral sciences. In: Boston, MA: Houghton Mifflin College Division.
Su, R., Snyder, C., Wu, A. W., Gross, A. L., Ji, J., Zhang, J., & Morlock, L. (2025). A systematic review of patient-reported outcome measures (PROMs) to assess health-related quality of life (HRQoL) for breast cancer patients who are undertaking adjuvant endocrine therapy. Qual Life Res, 34(9), 2471-2488. doi:10.1007/s11136-025-04004-y DOI: https://doi.org/10.1007/s11136-025-04004-y
Team, R. C. (2020). RA language and environment for statistical computing, R Foundation for Statistical. Computing, 9(7), 7-88.
Vliek, S. B., Noordhoek, I., Meershoek-Klein Kranenbarg, E., van Rossum, A. G. J., Dezentje, V. O., Jager, A., . . . Linn, S. C. (2022). Daily Oral Ibandronate With Adjuvant Endocrine Therapy in Postmenopausal Women With Estrogen Receptor-Positive Breast Cancer (BOOG 2006-04): Randomized Phase III TEAM-IIB Trial. J Clin Oncol, 40(25), 2934-2945. doi:10.1200/jco.21.00311 DOI: https://doi.org/10.1200/JCO.21.00311
Zemlin, C., Altmayer, L., Lang, M., Schleicher, J. T., Stuhlert, C., Wörmann, C., . . . Müller, C. (2024a). Course of Vitamin D Levels in Newly Diagnosed Non-Metastatic Breast Cancer Patients over One Year with Quarterly Controls and Substitution. Nutrients, 16(6), 6-43. doi:10.3390/nu16060854
Zemlin, C., Altmayer, L., Lang, M., Schleicher, J. T., Stuhlert, C., Wörmann, C.,. Müller, C. (2024b). Course of Vitamin D Levels in Newly Diagnosed Non-Metastatic Breast Cancer Patients over One Year with Quarterly Controls and Substitution. Nutrients, 16(6). doi:10.3390/nu16060854 DOI: https://doi.org/10.3390/nu16060854
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