骨保护对新辅助内分泌治疗早期乳腺癌患者骨密度的影响

Effects of bone protection on bone mineral density in patients with early breast cancer treated with neoadjuvant endocrine therapy

目的观察骨保护治疗对芳香化酶抑制剂辅助治疗乳腺癌患者骨密度(bone mineral density,BMD)的影响。方法回顾性研究97例接受芳香酶抑制剂治疗的激素受体阳性的早期乳腺癌患者,其中行骨保护治疗的71例,未行骨保护治疗26例,比较1年后腰椎和股骨颈BMD改变。所有患者每天摄入500 mg元素钙和至少400 IU的维生素D。结果行骨保护治疗的患者,1年后BMD与基线BMD相比,腰椎、股骨颈、髋部BMD平均值均有上升或保持不变,总腰椎(L总)BMD较基线上升2.1%,股骨颈(NECK)BMD较基线上升1.3%,髋部(HT)BMD保持不变。其中总腰椎BMD上升较明显(P<0.05)。在未行骨保护治疗的早期乳腺癌患者,1年后BMD与基线BMD相比,腰椎、股骨颈、髋部骨密度平均值均下降或保持不变,HT较基线下降1.0%,L总BMD下降2.1%,NECK BMD保持不变。其中L总BMD下降较明显(P<0.05)。结论每年2次唑来膦酸4 mg静滴的骨保护治疗可以预防接受辅助芳香酶抑制剂治疗早期乳腺癌患者骨量的进一步的流失。

Objective To observe the effect of bone protection therapy on the bone mineral density of breast cancer patients receiving adjuvant aromatase inhibitor therapy.Methods 97 cases of hormone receptor-positive early breast cancer patients receiving adjuvant aromatase inhibitor therapy were retrospectively studied.Among them,71 cases underwent bone protection treatment,and 26 cases did not undergo bone protection therapy.The changes in bone mineral density(BMD)of the lumbar spine and femoral neck were compared after 1 year.All patients received 500 mg of elemental calcium and at least 400 IU of vitamin D per day.Results Compared with the BMD of the baseline,the average BMD of the lumbar spine,femoral neck,and hip of patients undergoing bone protection therapy increased or remained unchanged after 1 year.The first lumbar spine(L1)and total lumbar spine(L total)increased by 2.1%from the baseline,the second lumbar spine(L2)and the third lumbar(L3)increased by 1.0%from the baseline,the femoral neck(NECK)increased by 1.3%from the baseline,and the BMD of the hip(HT)remained unchanged.Among them,The BMD of L1,L4 and total lumbar spine increased significantly(P<0.05).Compared with the BMD of the baseline,the average BMD of the lumbar spine,femoral neck,and hip of patients with early breast cancer did not undergo bone protection therapy decreased or remained unchanged after 1 year.L2 decreased by 2.0%from baseline,and L3,L4,HT decreased by 1.0%from baseline,L total decreased by 2.1%,L1 and NECK remained unchanged.Among them,BMD of L4 and L total decreased significantly(P<0.05).Conclusion Bone protection therapy with intravenous infusion of zoledronic acid 4 mg twice a year can prevent further bone loss in early breast cancer patients receiving adjuvant aromatase inhibitor therapy.