Servitja Sonia, Martos Tamara, Rodriguez Sanz Maria, Garcia-Giralt Natalia, Prieto-Alhambra Daniel, Garrigos Laia, Nogues Xavier, Tusquets Ignasi
Medical Oncology Department, Hospital del Mar Medical Research Institute, Barcelona, Spain.
Internal Medicine Department and URFOA-IMIM Department, Instituto de Salud Carlos III FEDER, Barcelona, Spain.
Ther Adv Med Oncol. 2015 Sep;7(5):291-6. doi: 10.1177/1758834015598536.
Aromatase inhibitors (AIs) are routinely used in the adjuvant treatment of women with hormone receptor-positive early breast cancer. Patients who receive AIs have an increased risk of bone loss and arthralgia compared with those treated with tamoxifen. In addition to the effects of AIs, the population of women with early breast cancer has a high prevalence of 25-hydroxyvitamin D (25(OH)D) insufficiency. In our experience 88% of patients had concentrations lower than 30 ng/ml. Vitamin D supplementation should be adapted to the baseline concentration. Another relevant finding in our research program was the close relationship between 25(OH)D levels and intensity of AI-related arthralgia (AIrA). A target concentration of 40 ng/ml 25(OH)D may prevent development of AIrA. We also demonstrate that AIrA is genetically determined: single nucleotide polymorphisms located in genes encoding key factors for the metabolism of estrogens and vitamin D (CYP17A1, VDR, and CYP27B1) are associated with self-reported arthralgia during AI therapy. We recommend establishing an individualized protocol of bone-health surveillance based on baseline and evolutionary clinical variables.
芳香化酶抑制剂（AIs）常用于激素受体阳性早期乳腺癌女性的辅助治疗。与接受他莫昔芬治疗的患者相比，接受AIs治疗的患者骨质流失和关节痛风险增加。除了AIs的影响外，早期乳腺癌女性人群中25-羟基维生素D（25(OH)D）不足的患病率很高。根据我们的经验，88%的患者浓度低于30 ng/ml。维生素D补充应根据基线浓度进行调整。我们研究项目中的另一个相关发现是25(OH)D水平与AI相关关节痛（AIrA）强度之间的密切关系。25(OH)D的目标浓度为40 ng/ml可能会预防AIrA的发生。我们还证明AIrA是由基因决定的：位于编码雌激素和维生素D代谢关键因子的基因（CYP17A1、VDR和CYP27B1）中的单核苷酸多态性与AI治疗期间自我报告的关节痛相关。我们建议根据基线和动态临床变量建立个性化的骨骼健康监测方案。
