Department of Breast Medical Oncology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Curr Opin Obstet Gynecol. 2010 Feb;22(1):61-6. doi: 10.1097/GCO.0b013e328334e43b.
To describe recent data on the effects of bisphosphonates on bone health for patients with primary breast cancer.
Data are accumulating regarding the salutary effect of bisphosphonates on bone health. Preservation of bone mineral density, a surrogate for fracture risk, has been demonstrated in randomized controlled trials of bisphosphonates. These trials have included premenopausal and postmenopausal women and endocrine and chemotherapy adjuvant breast cancer treatments. In these trials there has been a focus on gonadal dysfunction, use of aromatase inhibitors and the risk of osteopenia/osteoporosis. Data with bisphosphonates in this clinical setting have not confirmed clinical benefit for fracture risk.Adjuvant studies to assess the prevention of bone metastases have appropriate scientific rationale, including the potential antitumor effects of bisphosphonates, but large randomized controlled trials are incomplete.
The use of a bisphosphonate is warranted for preservation of bone mineral density in women with primary breast cancer and gonadal dysfunction or drug-induced hypoestrogenism. The potential additional benefit of delay or prevention of bone metastasis awaits confirmation from randomized controlled trials.Expert consensus panels have suggested guidelines for use of bisphosphonates for prevention of cancer treatment induced bone loss.
描述原发性乳腺癌患者双磷酸盐对骨骼健康影响的最新数据。
关于双磷酸盐对骨骼健康有益作用的数据正在不断积累。随机对照试验表明，双磷酸盐可维持骨矿物质密度，这是骨折风险的替代指标。这些试验包括绝经前和绝经后妇女、内分泌和化疗辅助乳腺癌治疗。这些试验的重点是性腺功能障碍、芳香酶抑制剂的使用和骨质疏松/骨量减少的风险。在这种临床环境中使用双磷酸盐的数据并未证实骨折风险降低的临床获益。评估预防骨转移的辅助研究具有合理的科学依据，包括双磷酸盐的潜在抗肿瘤作用，但大型随机对照试验尚未完成。
对于原发性乳腺癌伴性腺功能障碍或药物诱导的雌激素缺乏的女性，使用双磷酸盐可维持骨矿物质密度。从随机对照试验中确认延迟或预防骨转移的额外获益仍有待证实。专家共识小组建议使用双磷酸盐预防癌症治疗引起的骨丢失的指南。
