University of Marburg, Marburg, Germany.
National Cancer Institute, Naples, Italy.
Breast Cancer (Dove Med Press). 2012 Jun 20;4:91-101. doi: 10.2147/BCTT.S29432.
Postmenopausal women have an increased risk of osteopenia and osteoporosis due to loss of the bone-protective effects of estrogen. Disease-related processes may also contribute to the risk of bone loss in postmenopausal women with breast cancer. One of the most common and severe safety issues associated with cancer therapy for patients with breast cancer is bone loss and the associated increase in risk of fractures. This paper reviews the recent literature pertaining to aromatase inhibitor (AI)-associated bone loss, and discusses suggested management and preventative approaches that may help patients remain on therapy to derive maximum clinical benefit. A case study is presented to illustrate the discussion. We observed that AIs are in widespread use for women with hormone receptor-positive breast cancer and are now recommended as adjuvant therapy, either as primary therapy or sequential to tamoxifen, for postmenopausal women. AIs target the estrogen biosynthetic pathway and deprive tumor cells of the growth-promoting effects of estrogen, and AI therapies provide benefits to patients in terms of improved disease-free survival. However, there is a concern regarding the increased risk of bone loss with prolonged AI therapy, which can be managed in many cases with the use of bisphosphonates and other interventions (eg, calcium, vitamin D supplementation, exercise).
绝经后妇女由于雌激素对骨骼的保护作用丧失，发生骨质减少和骨质疏松的风险增加。与疾病相关的过程也可能导致乳腺癌绝经后妇女的骨丢失风险增加。与乳腺癌患者的癌症治疗相关的最常见和最严重的安全问题之一是骨丢失和骨折风险增加。本文回顾了与芳香化酶抑制剂（AI）相关的骨丢失的最新文献，并讨论了建议的管理和预防方法，这些方法可能有助于患者继续接受治疗以获得最大的临床获益。本文提出了一个病例研究来说明讨论。我们观察到，AI 广泛用于激素受体阳性乳腺癌女性，现在被推荐作为辅助治疗，无论是作为绝经后女性的一线治疗还是作为他莫昔芬的序贯治疗。AI 靶向雌激素生物合成途径，剥夺肿瘤细胞的雌激素促生长作用，AI 治疗为患者带来了无病生存期的改善。然而，人们担心长期 AI 治疗会增加骨丢失的风险，在许多情况下，可以使用双膦酸盐和其他干预措施（如钙、维生素 D 补充剂、运动）来治疗。
