Tzeng Huey-En, Muo Chih-Hsin, Chen Hsien-Te, Hwang Wen-Li, Hsu Horng-Chang, Tsai Chun-Hao
Graduate Institute of Clinical Medicine, China Medical University, #91 Hsueh-Shih Road, Taichung, 404, Taiwan.
Division of Hematology/Oncology, Taichung Veterans General Hospital, Taichung, Taiwan.
BMC Musculoskelet Disord. 2015 May 20;16:123. doi: 10.1186/s12891-015-0580-8.
Bone mineral density changes with tamoxifen treatment have been reported in pre- and post-menopausal women with breast cancer. However, there remains controversy as to whether tamoxifen significantly reduces fracture rates in different age groups. Breast cancer occurs at 10-20 years younger in Asian women compared with Western women. Therefore we conducted this population-based case-control study to determine whether or not tamoxifen use is associated with osteoporotic fractures.
We selected 75488 women with breast cancer with no prior history of fractures from the Longitudinal Health Insurance Database for Catastrophic Illness Patients in 2000-2011. They were followed from the date of the diagnosis of breast cancer to the date a hip, vertebral or wrist fracture occurred. Because the use of tamoxifen was a time-dependent variable, we used a Cox proportional hazard model with time-dependent exposure covariates to estimate the risk of a fracture.
There were 50257 and 25231 women with breast cancer who did and did not receive tamoxifen treatment, respectively. The tamoxifen users had lower risks for overall fractures with hazard ratios (HRs) of 0.52 and 0.59 in the crude and adjusted models (95 % CI = 0.45-0.61 and 0.51-0.69), respectively. They also had lower risks for hip (HR = 0.55, 95 % CI = 0.45-0.67) and vertebral (HR = 0.64, 95 % CI = 0.50-0.82) fractures in the adjusted model. The risk of fractures decreased with an increasing dosage of tamoxifen. Regardless of the age group, the tamoxifen users had a lower risk of fractures than the non-users.
In this Asian population-based case-control study, tamoxifen use was associated with a reduction in osteoporotic fractures, especially in hip fractures.
已有报道称，接受他莫昔芬治疗的绝经前和绝经后乳腺癌女性骨矿物质密度会发生变化。然而，他莫昔芬是否能显著降低不同年龄组的骨折发生率仍存在争议。与西方女性相比，亚洲女性患乳腺癌的年龄要小10 - 20岁。因此，我们开展了这项基于人群的病例对照研究，以确定使用他莫昔芬是否与骨质疏松性骨折有关。
我们从2000 - 2011年的重大疾病患者纵向健康保险数据库中选取了75488例无骨折病史的乳腺癌女性。从乳腺癌诊断之日起对她们进行随访，直至发生髋部、脊椎或腕部骨折之日。由于他莫昔芬的使用是一个随时间变化的变量，我们使用带有随时间变化的暴露协变量的Cox比例风险模型来估计骨折风险。
分别有50257例和25231例乳腺癌女性接受了和未接受他莫昔芬治疗。在粗模型和校正模型中，他莫昔芬使用者发生总体骨折的风险较低，风险比（HRs）分别为0.52和0.59（95%置信区间 = 0.45 - 0.61和0.51 - 0.69）。在校正模型中，他们发生髋部骨折（HR = 0.55，95%置信区间 = 0.45 - 0.67）和脊椎骨折（HR = 0.64，95%置信区间 = 0.50 - 0.82）的风险也较低。骨折风险随着他莫昔芬剂量的增加而降低。无论年龄组如何，他莫昔芬使用者发生骨折的风险均低于未使用者。
在这项基于亚洲人群的病例对照研究中，使用他莫昔芬与骨质疏松性骨折发生率降低有关，尤其是髋部骨折。
