Lomax Anna J, Yee Yap Saw, White Karen, Beith Jane, Abdi Ehtesham, Broad Adam, Sewak Sanjeev, Lee Chooi, Sambrook Philip, Pocock Nicholas, Henry Margaret J, Yeow Elaine G, Bell Richard
Andrew Love Cancer Centre, The Geelong Hospital, Victoria, Australia.
Andrew Love Cancer Centre, The Geelong Hospital, Victoria, Australia; St John of God Geelong Hospital, Victoria, Australia.
J Bone Oncol. 2013 Aug 15;2(4):145-53. doi: 10.1016/j.jbo.2013.08.001. eCollection 2013 Dec.
Postmenopausal women on aromatase inhibitors (AI) are at risk of aromatase inhibitor-associated bone loss (AIBL) and fractures. In 2005 Osteoporosis Australia proposed an algorithm for bisphosphonate intervention. Three hundred and three postmenopausal women with early breast cancer (EBC) were enrolled (osteoporotic, n=25; osteopaenic, n=146; normal bone mineral density (BMD), n=126). Weekly alendronate (70 mg) treatment efficacy as triggered by the algorithm in preventing bone loss was evaluated. All patients received anastrozole (1 mg daily), calcium and vitamin D.
All osteoporotic patients received alendronate at baseline. Eleven out of the 146 (7.5%) osteopaenic patients commenced alendronate within 18 months of participation and eleven commenced after. One hundred and twenty four out of the 146 (84.9%) osteopaenic patients and all 126 with normal baseline BMD did not trigger the algorithm. At three years, lumbar spine mean BMD increased (15.6%, p<0.01) in the osteoporotic group. BMD in the osteopaenic group with early intervention significantly increased at three years (6.3%, p=0.02). No significant change was seen in the late intervention group. No change was observed in those with osteopaenia without alendronate. There was a significant drop in lumbar spine (-5.4%) and hip (-4.5%) mean BMD, in the normal BMD group, none of whom received alendronate. Fracture data will be presented.
In postmenopausal women with endocrine-responsive EBC, BMD improved over time when a bisphosphonate is administered with anastrozole in osteoporotic patients using an osteoporosis schedule. Subjects with normal baseline BMD experienced the greatest BMD loss, although none became osteoporotic.
使用芳香化酶抑制剂（AI）的绝经后女性存在芳香化酶抑制剂相关骨质流失（AIBL）和骨折风险。2005年，澳大利亚骨质疏松症协会提出了双膦酸盐干预算法。招募了303名绝经后早期乳腺癌（EBC）女性（骨质疏松症患者25名；骨质减少患者146名；骨矿物质密度（BMD）正常患者126名）。评估了该算法触发的每周阿仑膦酸钠（70毫克）治疗在预防骨质流失方面的疗效。所有患者均接受阿那曲唑（每日1毫克）、钙和维生素D治疗。
所有骨质疏松症患者在基线时接受阿仑膦酸钠治疗。146名骨质减少患者中有11名（7.5%）在参与研究的18个月内开始使用阿仑膦酸钠，另有11名在18个月后开始使用。146名骨质减少患者中有124名（84.9%）以及所有基线BMD正常的126名患者未触发该算法。三年时，骨质疏松症组腰椎平均BMD增加（15.6%，p<0.01）。早期干预的骨质减少组BMD在三年时显著增加（6.3%，p=0.02）。晚期干预组未见显著变化。未使用阿仑膦酸钠的骨质减少患者未见变化。正常BMD组腰椎平均BMD显著下降（-5.4%），髋部平均BMD显著下降（-4.5%），该组患者均未接受阿仑膦酸钠治疗。骨折数据将另行公布。
在患有内分泌反应性EBC的绝经后女性中，对于骨质疏松症患者按照骨质疏松治疗方案将双膦酸盐与阿那曲唑联合使用时，BMD会随时间改善。基线BMD正常的受试者BMD损失最大，尽管无人发展为骨质疏松症。
