Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA.
CA Cancer J Clin. 2011 May-Jun;61(3):139-56. doi: 10.3322/caac.20103. Epub 2011 May 4.
As people with cancer survive longer, and as the US population ages, skeletal effects of cancer treatment are becoming more pronounced. This is particularly true for breast and prostate cancer survivors because of the high average age of patients with these malignancies, the propensity of older adults in general toward the development of osteoporosis, and the wide use of therapeutic agents in these cancers that negatively impact bone health. Various therapies used in the treatment and prevention of cancer may cause decreases in bone mineral density and an increased risk of debilitating fracture, even in the absence of bone metastases. Aging is both a baseline risk factor in the development of osteoporosis and bony fracture, as well as a predictor of poor outcome after fracture. A variety of mechanisms may be responsible for the development of bone loss in patients with breast or prostate cancer. Cytotoxic chemotherapy may directly exert long-term toxic effects on bone. Chemotherapy and endocrine therapy can induce hypogonadism, leading to an increased rate of bone loss. The risk of skeletal events in older adults due to cancer therapy should be appreciated by all oncologists, geriatricians, and internists. The following review may serve as a guide to the skeletal side effects of cancer therapy in older adults with breast or prostate cancer, how to screen for treatment-related bone loss, and how to best prevent and/or treat skeletal events.
随着癌症患者生存期的延长，以及美国人口的老龄化，癌症治疗对骨骼的影响变得更加明显。对于乳腺癌和前列腺癌幸存者来说尤其如此，因为这些恶性肿瘤患者的平均年龄较高，一般老年人更容易发生骨质疏松症，以及这些癌症中广泛使用的对骨骼健康有负面影响的治疗药物。各种用于治疗和预防癌症的疗法可能导致骨矿物质密度降低，并增加致残性骨折的风险，即使没有骨转移也是如此。衰老既是骨质疏松症和骨骨折发生的基线风险因素，也是骨折后不良预后的预测因素。多种机制可能导致乳腺癌或前列腺癌患者发生骨丢失。细胞毒性化疗可能直接对骨骼产生长期毒性作用。化疗和内分泌治疗可诱发性腺功能减退，导致骨丢失率增加。所有肿瘤学家、老年病学家和内科医生都应该认识到癌症治疗对老年人骨骼事件的风险。以下综述可作为乳腺癌或前列腺癌老年患者癌症治疗相关骨骼副作用、如何筛查与治疗相关的骨丢失以及如何最好地预防和/或治疗骨骼事件的指南。
