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Effect of a randomized controlled exercise trial on bone outcomes: influence of adjuvant endocrine therapy

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Abstract

Bone loss is a significant clinical problem for female cancer survivors (FCS) and increases fracture risk. The aim of the Yale Fitness Intervention Trial (Yale FIT) was to determine the effects of a 12-month aerobic–resistance exercise intervention compared to a home-based physical activity group on bone outcomes [bone mineral density (BMD)] and biomarkers bone turnover). Early postmenopausal FCS (N = 154) were randomized to the exercise intervention (3 times/week) or to a home-based physical activity group. Calcium (1200 mg) and Vitamin D (400 IU) supplements were provided to both groups. BMD was measured at baseline and 12 months. No significant difference in BMD was observed for the exercise vs home-based group. However, subjects on Tamoxifen or no endocrine therapy did not significantly lose BMD, with the exception of the femoral neck (FN). In contrast subjects on aromatase inhibitors (AIs) had significant BMD loss at all sites. The majority of subjects had sufficient serum levels of Vitamin D (>20 ng/mL) but there was significantly less bone loss in subjects in the 20–29 ng/mL range at the LS (p = 0.01), hip (p = 0.03), and GT (p = 0.008) compared to lower or higher levels. Exercise stimulates bone remodeling but the intervention was not superior for BMD outcomes at one year. The dose of the osteogenic stimulus in the intervention has been effective in preserving BMD in healthy postmenopausal women but it may be inadequate for survivors with chemotherapy-induced menopause and for those on adjuvant AI therapy.

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Acknowledgments

This publication was made possible by National Institute of Health/National Cancer Institute R01CA122658 and the Yale CTSA Grant UL1TR000142 from the National Center for Advancing Translational Science (NCATS), National Institute of Health.

Contributions

C. Gunberg (Ostecalcin analysis), C. Simpson (NTX analysis) D. Brown, P. Galasso (interventionists), M. Cunningham (research assistant), S. Park (PhD student).

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Authors and Affiliations

  1. Yale University School of Nursing, 400 West Campus Dr., Orange, CT, 06477, USA

    M. Tish Knobf & Sangchoon Jeon

  2. Michigan State University, East Lansing, USA

    Barbara Smith

  3. Director Breast Cancer Program, UH Seidman Cancer Center, Cleveland, USA

    Lyndsay Harris

  4. Case Western Reserve University School of Medicine, Cleveland, USA

    Lyndsay Harris

  5. University of Connecticut, Storrs, USA

    Jane Kerstetter

  6. Yale Cancer Center, New Haven, USA

    A. Siobhan Thompson

  7. Yale Musculoskeletal Center, Yale University School of Medicine, New Haven, USA

    Karl Insogna

Authors
  1. M. Tish Knobf
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  2. Sangchoon Jeon
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  3. Barbara Smith
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  4. Lyndsay Harris
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Correspondence to M. Tish Knobf.

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Conflict of Interest

The authors state no conflict of interest except Dr. Insogna, who has received research grants from Kyowa Hakko Kirin Pharma, unrelated to this study.

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Knobf, M.T., Jeon, S., Smith, B. et al. Effect of a randomized controlled exercise trial on bone outcomes: influence of adjuvant endocrine therapy. Breast Cancer Res Treat 155, 491–500 (2016). https://doi.org/10.1007/s10549-016-3693-3

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  • DOI: https://doi.org/10.1007/s10549-016-3693-3

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