Christensen Carina Ørts, Cronin-Fenton Deirdre, Frøslev Trine, Hermann Anne Pernille, Ewertz Marianne
Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark.
Institute of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000, Odense C, Denmark.
Support Care Cancer. 2016 Oct;24(10):4229-36. doi: 10.1007/s00520-016-3250-y. Epub 2016 May 5.
Adjuvant chemotherapy has been associated with loss of bone mineral density (BMD) either as a direct effect or due to glucocorticoids used as supportive care medication. A prospective cohort study was conducted to evaluate changes in BMD from baseline to right after completion of chemotherapy, i.e., 4 months.
Dual-imaging X-ray absorptiometry (DXA) was performed at baseline and after completing anthracycline- and taxane-based chemotherapy to measure BMD in the spine, hip, and forearm in early-stage breast cancer patients. High-dose prednisolone was used at three weekly intervals to reduce nausea and vomiting. Patients were advised a daily calcium/vitamin D supplement. Linear regression was used to assess mean percentage change in BMD and 95 % confidence intervals (95 % CI) according to doses of prednisolone, menopausal status, smoking, and BMI.
Eight patients were excluded: seven because of initiation of bisphosphonate treatment due to osteoporosis at baseline, and one had non-interpretable DXA. The final cohort included 97 patients with a mean age of 53 years (range 34-72). Mean cumulative prednisolone dose was 1308 mg (95 % CI 1255; 1362). BMD increased 1.36 % (95 % CI 0.7; 2.0, p < 0.001) in the spine and 1.27 % (95 % CI 0.9; 1.7, p < 0.001) in the hip. Forearm BMD did not change. Postmenopausal women had increases in spine BMD of 2.35 % (95 % CI 1.1; 3.6, p < 0.001) compared to premenopausal women. The spine BMD of current smokers decreased 1.67 % (95 % CI -3.3; -0.1, p = 0.04) compared to never/former smokers.
Adjuvant chemotherapy supplemented with prednisolone was not associated with loss of BMD. Postmenopausal women gained bone mass, whereas current smokers lost bone mass.
辅助化疗与骨密度（BMD）降低有关，这可能是直接作用，也可能是由于使用糖皮质激素作为支持性护理药物所致。本前瞻性队列研究旨在评估从基线到化疗结束后4个月时骨密度的变化。
对早期乳腺癌患者在基线时以及完成基于蒽环类和紫杉烷类的化疗后，采用双能X线吸收法（DXA）测量脊柱、髋部和前臂的骨密度。每3周使用一次高剂量泼尼松龙以减轻恶心和呕吐。建议患者每日补充钙/维生素D。采用线性回归分析，根据泼尼松龙剂量、绝经状态、吸烟情况和体重指数（BMI）评估骨密度的平均百分比变化及95%置信区间（95%CI）。
8例患者被排除：7例因基线时因骨质疏松开始使用双膦酸盐治疗，1例DXA结果无法解读。最终队列包括97例患者，平均年龄53岁（范围34 - 72岁）。泼尼松龙平均累积剂量为1308mg（95%CI 1255；1362）。脊柱骨密度增加1.36%（95%CI 0.7；2.0，p＜0.001），髋部骨密度增加1.27%（95%CI 0.9；1.7，p＜0.001）。前臂骨密度无变化。与绝经前女性相比，绝经后女性脊柱骨密度增加2.35%（95%CI 1.1；3.6，p＜0.001）。与从不吸烟/曾经吸烟者相比，当前吸烟者的脊柱骨密度降低1.67%（95%CI -3.3；-0.1，p = 0.04）。
补充泼尼松龙的辅助化疗与骨密度降低无关。绝经后女性骨量增加，而当前吸烟者骨量减少。
