乳腺癌芳香化酶抑制剂治疗期间骨丢失的长期随访结果

Bone loss in breast cancer patients treated with aromatase inhibitors: Results of a long-term follow-up

目的 评估绝经后激素受体阳性早期乳腺癌患者术后5年芳香化酶抑制剂(aromatase inhibitor, AI)辅助内分泌治疗过程中的骨丢失情况,为骨健康管理提供依据。方法 本研究为前瞻性观察性研究,入组绝经后激素受体阳性早期乳腺癌患者,接受股骨颈、全髋和腰椎L1-L4等部位的双能X线骨密度检测。AI辅助内分泌治疗前进行基线骨密度检查,治疗期间每年检查骨密度1次。分析AI治疗过程中骨密度变化以及骨质疏松发生率。结果 2013年11月至2016年8月共纳入131例患者,中位年龄60岁,中位绝经年龄50岁,AI治疗时间60~100个月。中位随访86个月,AI治疗5年期间患者腰椎、股骨颈、全髋骨密度逐年下降,5年骨密度总下降率分别为6.90%、5.68%、7.14%,其中第1年骨密度下降最快,第2~5年骨密度平稳下降。腰椎骨密度第1年变化率显著高于第2~5年骨密度变化率(P<0.01)。进一步分层分析显示,基线骨密度、年龄以及体质量指数值未影响患者骨密度下降率。5年间共17例(17%)患者新发骨质疏松,其中15例为基线骨量低下患者,76%出现在腰椎(13/17),骨折发生率2%(2/100)。结论 绝经后早期乳腺癌患者5年AI辅助内分泌治疗期间骨密度呈持续下降趋势。应加强AI治疗期间的骨健康管理,早期干预减少骨质疏松的发生。

Objective To evaluate the bone loss of postmenopausal early-stage breast cancer in Chinese patients during 5-year aromatase inhibitor(AI)adjuvant endocrine therapy and to provide the basis for bone health management.Methods The study was a prospective observational study.Patients with estrogen receptor(ER)and/or progesterone receptor(PR)positive postmenopausal early breast cancer had to take an examination for bone mineral density(BMD)before starting AI adjuvant endocrine therapy.BMD of the femoral neck,total hip,and the lumbar spine was detected using dual-energy X-ray absorptiometry.During the treatment,patients needed to receive BMD annually and were followed up regularly.The changes of BMD and the incidence of osteoporosis during AI treatment were analyzed.Results From November 2013 to August 2016,131 patients with breast cancer meeting the inclusion criteria were enrolled.Their median age was 60 years old,median menopausal age was 50,and the treatment time of AI was 60 to 100 months.With a median follow-up of 86 months,BMD of the lumbar spine L1 to L4,femoral neck,and total hip decreased year by year during the 5-year AI treatment.The total BMD decrease rate in 5 years was 6.90%,5.68%,and 7.14%,respectively.BMD decreased most rapidly in the first year and decreased steadily from 2 to 5 years.The change rate of lumbar spine BMD in the first year was significantly higher than that from 2 to 5 years(P<0.01).Further stratified analysis showed that baseline BMD,age,and BMI did not affect the decreasing rate of BMD.Seventeen patients(17%)had new-onset osteoporosis during the 5 years,including 15 patients with baseline bone mass loss,76%of whom occurred in the lumbar spine(13/17),and the fracture incidence was 2%(2/100).Conclusion BMD in postmenopausal early breast cancer patients decreases year by year during the AI adjuvant endocrine therapy.Bone health management during AI treatment should be strengthened and early intervention should be taken to reduce the occurrence of osteoporosis.