Journal of Endocrinological Investigation

, Volume 42, Issue 11, pp 1337–1343 | Cite as

Trabecular bone score and quantitative ultrasound measurements in the assessment of bone health in breast cancer survivors assuming aromatase inhibitors

  • A. CatalanoEmail author
  • A. Gaudio
  • R. M. Agostino
  • N. Morabito
  • F. Bellone
  • A. Lasco
Original Article



Aromatase inhibitors (AIs) represent the first-line adjuvant therapy for hormone receptor-positive breast cancer (BC) women. AIs have been associated with an increased rate of fractures. The aim of our study was to investigate trabecular bone score (TBS) and bone quantitative ultrasound (QUS) measurements as bone quality surrogates in AIs users.


Sixty postmenopausal BC women starting AIs and forty-two controls (mean age 61.64 ± 8.33 years) were considered. Bone mineral density (BMD) at lumbar spine and femoral neck and TBS were measured by DXA; QUS-derived Amplitude-Dependent Speed of Sound (AD-SoS), Bone Transmission Time (BTT), and Ultrasound Bone Profile Index (UBPI) were assessed at phalangeal site; morphometric vertebral fractures (Vfx) by X-ray, serum bone-specific alkaline phosphatase (BSAP), and C-telopeptide of type 1 collagen (CTX) were also evaluated.


After 18 months, changes of TBS vs baseline were significantly different between AIs group and controls [Δ TBS − 2.2% vs − 0.4%, respectively, p = 0.001]. AD-SoS, BTT and UBPI values decreased only in AIs’ group (− 3.7%, − 6.45%, −8.5%, vs baseline, respectively, pall < 0.001). 3 Vfx occurred in AIs users and were associated with the greater TBS and AD-SoS modifications. In the AIs’ group, ΔTBS was associated with ΔAD-SoS (r = 0.58, p < 0.001) and ΔUBPI (r = 0.415, p = 0.001), but not with ΔBMD. Moreover, ΔTBS was independently predicted by ΔAD-SoS, after correcting for BMD, CTX and BSAP level changes (β = 0.37, SE = 2.44, p < 0.001).


TBS and phalangeal QUS provide useful information related to bone quality in AI-treated BC survivors and could be considered for fracture risk evaluation.


Trabecular bone score Quantitative ultrasound Bone quality Osteoporosis Aromatase inhibitors Breast cancer 



This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Compliance with ethical standards

Conflicts of interest

Antonino Catalano, Agostino Gaudio, Rita Maria Agostino, Nunziata Morabito, Federica Bellone, and Antonino Lasco declare that they have no conflicts of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all participants included in the study.


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Copyright information

© Italian Society of Endocrinology (SIE) 2019

Authors and Affiliations

  • A. Catalano
    • 1
    Email author
  • A. Gaudio
    • 2
  • R. M. Agostino
    • 3
  • N. Morabito
    • 1
  • F. Bellone
    • 1
  • A. Lasco
    • 1
  1. 1.Department of Clinical and Experimental MedicineUniversity Hospital of MessinaMessinaItaly
  2. 2.Department of Clinical and Experimental MedicineUniversity of CataniaCataniaItaly
  3. 3.Medical Oncology UnitGrand Metropolitan Hospital “Bianchi Melacrino Morelli”Reggio CalabriaItaly

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