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Title: [A prospective study of bone loss in early stage postmenopausal breast cancer treated with aromatase inhibitors].
Author: Sun J, Wang Q, Wang L, Gui L, Li Q, Luo Y, Zhang S, Zhang P.
Journal: Zhonghua Zhong Liu Za Zhi; 2020 May 23; 42(5):403-407. PubMed ID: 32482030.
Abstract:
Objective: To investigate the occurrence and development of aromatase inhibitors (AIs) related bone loss in Chinese patients with postmenopausal early-stage breast cancer. Methods: Patients with estrogen receptor (ER) and (or) progesterone receptor(PR) positive postmenopausal early-stage breast cancer who received Letrozole, Anastrozole, or Exemestane as adjuvant therapy were enrolled. Before treatment, baseline bone mineral density (BMD), bone metabolism markers were examined and a lifestyle questionnaire was completed; BMD was examined annually during the treatment; Outpatient visits were conducted to record recurrent and fatal events. Results: From November 2013 to August 2016, 131 patients with breast cancer eligible for enrollment were enrolled. A total of 65 patients had normal baseline bone mass, and 68 patients had reduced bone mass. Letrozole was taken in 69 patients, anastrozole in 52 patients, and exemestane in 10 patients. With a median follow-up of 43.7 months, 100 patients could be evaluated for changes in bone mineral density. Bone mineral density of femoral neck, total hip, and lumbar spine L1 to 4 decreased year by year, and the decrease was the most significant in the first year, which decreased by 2.3%, 2.4%, and 3.9% respectively. Ten new cases of osteoporosis occurred in two years, eight of them occurred in the lumbar spine, all of whom had reduced bone mass at baseline. Among the 131 patients who completed the lifestyle questionnaire, the proportions of daily calcium supplementation and vitamin D were 28.2% and 7.6%, respectively; more than half (52.7%) of them lacked regular exercise. Conclusion: BMD was declining steadily in patients treated with AIs, especially in the first year. Lumbar spine is the most common osteoporosis site, early prevention and health education should be strengthened. 目的： 了解中国绝经后早期乳腺癌患者接受芳香化酶抑制剂(AIs)辅助治疗后的骨丢失情况。 方法： 选择手术治疗后的雌激素受体(ER)和(或)孕激素受体(PR)阳性绝经后早期乳腺癌患者，服用来曲唑、阿那曲唑或依西美坦行辅助内分泌治疗。治疗前，患者填写生活方式调查问卷，进行基线骨密度和骨代谢标志物检测。治疗过程中，患者每年检查骨密度1次，随访并记录复发和死亡事件。 结果： 2013年11月至2016年8月纳入符合入组条件的乳腺癌患者131例，基线骨量正常65例，骨量减少68例。69例服用来曲唑，52例服用阿那曲唑，10例服用依西美坦。中位随访43.7个月，100例患者可评价骨密度变化。股骨颈、全髋和腰椎L1～4骨密度逐年下降，其中第1年下降最明显，分别下降2.3%、2.4%和3.9%。2年间新发骨质疏松10例，其中8例发生在腰椎，均为基线骨量减少者。131例完成生活方式问卷调查的患者中，日常补充钙剂和维生素D的比例较低，分别为28.2%和7.6%；半数以上(52.7%)日常缺乏适度锻炼。 结论： 绝经后早期乳腺癌患者接受AIs辅助治疗后骨密度逐年下降，其中第1年下降最显著，腰椎是发生骨质疏松的最常见部位。绝经后早期乳腺癌患者日常钙和维生素D补充不足比较普遍，应尽早采取防护措施，加强健康宣教。.

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