Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
Osteoporos Int. 2017 Apr;28(4):1413-1422. doi: 10.1007/s00198-016-3899-6. Epub 2017 Jan 12.
In non-osteoporotic postmenopausal women with breast cancer, aromatase inhibitors (AIs) negatively affected bone mineral density (BMD), lumbar spine trabecular bone score (TBS) as a bone microarchitecture index, and hip geometry as a bone macroarchitecture index.
AIs increase the risk of fracture in patients with breast cancer. Therefore, we aimed to evaluate the long-term skeletal effects of AIs in postmenopausal women with primary breast cancer.
We performed a retrospective longitudinal observational study in non-osteoporotic patients with breast cancer who were treated with AIs for ≥3 years (T-score >-2.5). Patients with previous anti-osteoporosis treatment or those who were given bisphosphonate during AI treatment were excluded from the analysis. We serially assessed BMD, lumbar spine TBS, and hip geometry using dual-energy X-ray absorptiometry.
BMD significantly decreased from baseline to 5 years at the lumbar spine (-6.15%), femur neck (-7.12%), and total hip (-6.35%). Lumbar spine TBS also significantly decreased from baseline to 5 years (-2.12%); this change remained significant after adjusting for lumbar spine BMD. The annual loss of lumbar spine BMD and TBS slowed after 3 and 1 year of treatment, respectively, although there was a relatively constant loss of BMD at the femur neck and total hip for up to 4 years. The cross-sectional area, cross-sectional moment of inertia, minimal neck width, femur strength index, and section modulus significantly decreased, although the buckling ratio increased over the treatment period (all P < 0.001); these changes were independent of total hip BMD.
Long-term adjuvant AI treatment negatively influenced bone quality in addition to BMD in patients with breast cancer. This study suggests that early monitoring and management are needed in non-osteoporotic patients with breast cancer who are starting AIs.
在非骨质疏松绝经后乳腺癌女性中，芳香酶抑制剂（AIs）会对骨密度（BMD）、腰椎骨小梁骨评分（TBS）作为骨微结构指数以及髋部几何结构作为骨宏观结构指数产生负面影响。
AIs 会增加乳腺癌患者骨折的风险。因此，我们旨在评估 AIs 在原发性乳腺癌绝经后女性中的长期骨骼影响。
我们进行了一项回顾性纵向观察性研究，纳入了接受 AIs 治疗≥3 年（T 评分>-2.5）的非骨质疏松乳腺癌患者。排除了有既往抗骨质疏松治疗或 AI 治疗期间使用双膦酸盐的患者。我们使用双能 X 线吸收法连续评估 BMD、腰椎 TBS 和髋部几何结构。
BMD 从基线到 5 年时腰椎（-6.15%）、股骨颈（-7.12%）和全髋（-6.35%）显著降低。腰椎 TBS 也从基线到 5 年显著降低（-2.12%）；在调整腰椎 BMD 后，这种变化仍然显著。治疗 3 年后腰椎 BMD 和 TBS 的年损失速度分别减慢，尽管股骨颈和全髋的 BMD 持续损失长达 4 年。在治疗期间，横截面积、截面惯性矩、最小颈宽、股骨强度指数和截面模量显著降低，尽管屈曲比增加（所有 P<0.001）；这些变化独立于全髋 BMD。
长期辅助 AI 治疗除了对乳腺癌患者的 BMD 产生负面影响外，还会对骨质量产生影响。本研究表明，开始使用 AIs 的非骨质疏松乳腺癌患者需要早期监测和管理。
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