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Symptom Management and Supportive Care

Evaluation of Vitamin D Deficiency in Breast Cancer Patients on Bisphosphonates

^aDivision of Oncology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA; ^bDivision of Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

Key Words. Vitamin D deficiency • Breast cancer • Bisphosphonates • 25-Hydroxyvitamin D • Hyperparathyroidism

Correspondence: Laura F. Hutchins, M.D., Division of Hematology/Oncology, Slot 508, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA. Telephone: 501-686-8511; Fax: 501-686-6342; e-mail: HutchinsLauraF{at}uams.edu

Received January 15, 2008; accepted for publication April 14, 2008; first published online in THE ONCOLOGIST Express on July 9, 2008.

Disclosure: The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors, planners, independent peer reviewers, or staff managers.

Background. Bisphosphonates are very effective in treating osteoporosis and metastatic bone disease; however, unfavorable outcomes can occur when they are given to patients with occult vitamin D deficiency. No clear consensus exists on the assessment of vitamin D status in cancer patients undergoing bisphosphonate therapy. This study examines the prevalence of vitamin D deficiency among breast cancer patients treated with bisphosphonates for osteoporosis or metastatic bone disease, and observes the use of calcium and vitamin D supplementation in these patients.

Methods. This retrospective study reviewed the electronic records of 321 breast cancer patients treated with bisphosphonates. Information on age, race, and serum levels of 25-hydroxyvitamin D (25-OHD), parathyroid hormone, and calcium were collected, and intakes of calcium and vitamin D supplements were queried in an outpatient pharmacy database.

Results. Of the 321 patients treated with bisphosphonates, 209 (65.1%) had their 25-OHD levels checked at least once. Of these patients, 57 (27.3%) had a serum 25-OHD level <20 ng/ml. Of the 209 patients with a known 25-OHD level, only eight (3.8%) received >600 IU of vitamin D per day, and 41 (19.6%) patients received 400–600 IU of vitamin D daily.

Conclusion. Especially in the setting of metastatic bone disease in breast cancer patients, we advocate routine 25-OHD concentration screening for vitamin D deficiency in general. Clear guidelines for the diagnosis of vitamin D deficiency in cancer patients would be extremely beneficial to have, as would identification of the proper dose of vitamin D supplementation. We recommend 1,000 IU daily to our metastatic cancer patients.

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