Mann G Bruce, Kang Y Chiu, Brand Caroline, Ebeling Peter R, Miller Julie A
Royal Women's Hospital, Parkville, Victoria, 3052, Australia.
J Clin Oncol. 2009 Aug 1;27(22):3605-10. doi: 10.1200/JCO.2008.20.2549. Epub 2009 Jun 22.
An observational study to assess the prevalence of secondary causes of low bone density in patients with breast cancer.
Female patients within 5 years of breast cancer diagnosis and age older than 50 years at diagnosis were recruited. Consenting patients completed a questionnaire and had blood taken for serum calcium, vitamin D, parathyroid hormone (PTH), and thyroid function testing. Bone mineral density (BMD) was assessed. Abnormalities were additionally investigated and treated.
Two hundred patients were recruited. The median age at diagnosis was 62 years. One hundred sixty-nine patients had hormone receptor (HR) -positive cancer. Vitamin D and thyroid function were assessed in 200 patients; PTH was assessed in 197 patients; and BMD was assessed in 187 patients. Eighty-seven patients (46.5%) had osteopenia, and 24 patients (12.8%) had osteoporosis. Vitamin D levels were insufficient (ie, 50 to 75 nmol/L) in 74 patients (37%) and were deficient (ie, < 50 nmol/L) in 54 patients (27%). Only 24 of 65 patients taking vitamin D supplements were replete (ie, > 75 nmol/L). Thirty-nine (21%) of 197 patients had PTH concentrations greater than the normal range. Six had primary hyperparathyroidism (PHPT), and two more had recent surgery for PHPT. Twenty-seven had secondary hyperparathyroidism (HPT) from vitamin D deficiency and six had normocalcemic HPT. Of 90 patients with low BMD and HR-positive cancer, 8% (seven of 90 patients) had new or recent PHPT, and 63% (57 of 90 patients) had insufficient or deficient vitamin D. More patients with HR-positive cancer than with HR-negative cancer had elevated PTH (38 of 167 v three of 30 patients, respectively; P = .10).
Secondary causes of low BMD are common in postmenopausal women. Identification and management of secondary causes should be included in bone health management algorithms.
一项观察性研究，旨在评估乳腺癌患者骨密度降低的继发原因的患病率。
招募确诊乳腺癌5年内且确诊时年龄超过50岁的女性患者。同意参与的患者完成一份问卷，并采集血液进行血清钙、维生素D、甲状旁腺激素（PTH）和甲状腺功能检测。评估骨密度（BMD）。对异常情况进行进一步调查和治疗。
招募了200名患者。确诊时的中位年龄为62岁。169名患者患有激素受体（HR）阳性癌症。对200名患者进行了维生素D和甲状腺功能评估；对197名患者进行了PTH评估；对187名患者进行了BMD评估。87名患者（46.5%）患有骨质减少症，24名患者（12.8%）患有骨质疏松症。74名患者（37%）的维生素D水平不足（即50至75 nmol/L），54名患者（27%）的维生素D水平缺乏（即<50 nmol/L）。在65名服用维生素D补充剂的患者中，只有24名患者的维生素D水平充足（即>75 nmol/L）。197名患者中有39名（21%）的PTH浓度高于正常范围。6名患者患有原发性甲状旁腺功能亢进症（PHPT），另外2名患者近期接受了PHPT手术。27名患者因维生素D缺乏导致继发性甲状旁腺功能亢进症（HPT），6名患者患有血钙正常的HPT。在90名骨密度低且HR阳性癌症的患者中，8%（90名患者中的7名）患有新发或近期的PHPT，63%（90名患者中的57名）维生素D不足或缺乏。HR阳性癌症患者中PTH升高的人数多于HR阴性癌症患者（分别为167名患者中的38名和30名患者中的3名；P = 0.10）。
绝经后女性骨密度降低的继发原因很常见。继发原因的识别和管理应纳入骨骼健康管理方案中。
