Bell R, Lewis J
Andrew Love Cancer Centre, Geelong Hospital, Victoria, Australia.
Curr Med Res Opin. 2007 May;23(5):1045-51. doi: 10.1185/030079907x187919.
To understand better the true impact of widespread adoption of adjuvant aromatase inhibitor (AI) therapy on postmenopausal breast cancer patients' risk of bone fracture.
Data from three different studies were used to estimate the relative risk of bone fracture for each of the following groups of women (i.e., versus a control group of healthy postmenopausal women): (a) healthy postmenopausal women receiving tamoxifen; (b) postmenopausal women who had received treatment for early breast cancer; (c) postmenopausal breast cancer patients on adjuvant tamoxifen therapy; (d) postmenopausal breast cancer patients on adjuvant anastrozole therapy. The results of these analyses were then used to estimate the likely incidence of clinical fracture among such populations in 'real-life' clinical practice.
Breast cancer survivors were calculated to be at increased risk of clinical bone fracture (i.e., RR 1.15 vs. control group over 5 years). Breast cancer patients initiated on adjuvant anastrozole were also calculated to be at increased risk of bone fracture (RR = 1.36 vs. control group over 5 years), while the calculated risk of fracture among tamoxifen-treated breast cancer patients was similar to that observed in the control population (RR = 0.91).
Breast cancer patients are at increased risk of clinical bone fracture (compared with the general postmenopausal population) and adjuvant anastrozole therapy slightly adds to this risk. Importantly, however, the absolute risk of bone fracture appears to remain low in each of the evaluated patient populations, suggesting that fear of fracture should not prevent the initiation of adjuvant aromatase inhibitor therapy.
更深入了解辅助性芳香化酶抑制剂（AI）疗法的广泛应用对绝经后乳腺癌患者骨折风险的实际影响。
来自三项不同研究的数据被用于估计以下几组女性（即与健康绝经后女性对照组相比）的骨折相对风险：（a）接受他莫昔芬治疗的健康绝经后女性；（b）接受早期乳腺癌治疗的绝经后女性；（c）接受辅助性他莫昔芬治疗的绝经后乳腺癌患者；（d）接受辅助性阿那曲唑治疗的绝经后乳腺癌患者。然后，这些分析结果被用于估计此类人群在“现实生活”临床实践中临床骨折的可能发生率。
经计算，乳腺癌幸存者临床骨折风险增加（即5年期间相对风险为1.15，与对照组相比）。开始接受辅助性阿那曲唑治疗的乳腺癌患者经计算骨折风险也增加（5年期间相对风险 = 1.36，与对照组相比），而接受他莫昔芬治疗的乳腺癌患者的计算骨折风险与对照组观察到的风险相似（相对风险 = 0.91）。
乳腺癌患者临床骨折风险增加（与一般绝经后人群相比），辅助性阿那曲唑疗法会略微增加此风险。然而，重要的是，在每个评估的患者群体中，骨折的绝对风险似乎仍然较低，这表明对骨折的担忧不应妨碍开始辅助性芳香化酶抑制剂治疗。
