Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Osteoporos Int. 2011 Nov;22(11):2847-55. doi: 10.1007/s00198-010-1493-x. Epub 2010 Dec 18.
The risk of hip and other fractures was examined among a population-based group of older women with breast cancer. Women using aromatase inhibitors (AIs) were found to be over three times more likely to have a hip fracture over approximately 3 years' follow-up. Other fracture risk factors were also identified.
Aromatase inhibitors have been shown in randomized trials to increase total fracture risk compared with tamoxifen, but the fracture risks in the trials were relatively low, and no difference in hip fracture has been demonstrated.
A population-based cohort of 2003 breast cancer survivors ≥65 were followed prospectively for a median of 36 months. Patient survey information regarding adjuvant breast cancer therapies, prescription osteoporosis treatments, and other factors potentially associated with fracture was supplemented with cancer registry information. Hip and total nonvertebral fractures were determined using a validated Medicare algorithm, and the association of these fractures with adjuvant hormonal therapies was examined using Cox models.
The cohort of 2,748 women with a mean age of 72.8 (SD 5.4) included 28.2% who took an aromatase inhibitor and 27.8% tamoxifen. There were 41 hip fractures (1.5%) and 218 nonvertebral fractures (7.9%) among the cohort. Subjects using AIs (adjusted hazard ratio 3.24 (1.05, 9.98)) and subjects not using hormone therapy (3.32 (1.14, 9.65)) were more likely than users of tamoxifen to have a hip fracture. Bisphosphonate use was more common among AI users but did not explain these results. Users of AIs were more likely to have nonvertebral fractures, but this result did not reach statistical significance (adjusted hazard 1.34 (0.92, 1.94)).
Hip and other fractures were common in an older population-based cohort of breast cancer survivors, and aromatase inhibitor use was associated with an increase in the short-term risk of hip fractures not detected in randomized controlled trials.
研究了基于人群的老年乳腺癌女性中，芳香酶抑制剂（AIs）的使用与髋部和其他骨折风险之间的关系。研究发现，在大约 3 年的随访中，使用芳香酶抑制剂的女性髋部骨折的风险是使用他莫昔芬的女性的三倍以上。还确定了其他骨折危险因素。
随机试验已表明，与他莫昔芬相比，芳香酶抑制剂会增加总骨折风险，但试验中的骨折风险相对较低，并且尚未证明髋部骨折有差异。
对 2003 名年龄≥65 岁的乳腺癌幸存者进行了基于人群的前瞻性队列研究，中位随访时间为 36 个月。患者调查信息包括辅助乳腺癌治疗、处方骨质疏松治疗以及其他可能与骨折相关的因素，辅以癌症登记信息。使用经过验证的 Medicare 算法确定髋部和非椎体骨折，并使用 Cox 模型检查这些骨折与辅助激素治疗的关系。
该队列包括 2748 名平均年龄为 72.8（标准差 5.4）岁的女性，其中 28.2%的人服用了芳香酶抑制剂，27.8%的人服用了他莫昔芬。该队列中有 41 例髋部骨折（1.5%）和 218 例非椎体骨折（7.9%）。使用 AI 的受试者（调整后的危险比 3.24（1.05，9.98））和未使用激素治疗的受试者（3.32（1.14，9.65））比使用他莫昔芬的受试者更有可能发生髋部骨折。AI 使用者中使用双膦酸盐更为常见，但并未解释这些结果。AI 使用者更有可能发生非椎体骨折，但该结果未达到统计学意义（调整后的危险比 1.34（0.92，1.94））。
在基于人群的老年乳腺癌幸存者队列中，髋部和其他骨折很常见，芳香酶抑制剂的使用与短期髋部骨折风险增加有关，而这种风险在随机对照试验中并未检测到。
