Department of Oncology and Metabolism, Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield, UK.
Calcif Tissue Int. 2018 Feb;102(2):251-264. doi: 10.1007/s00223-017-0369-x. Epub 2018 Jan 20.
Considerable advances in oncology over recent decades have led to improved survival, while raising concerns about long-term consequences of anticancer treatments. In patients with breast or prostate malignancies, bone health is a major issue due to the high risk of bone metastases and the frequent prolonged use of hormone therapies that alter physiological bone turnover, leading to increased fracture risk. Thus, the onset of cancer treatment-induced bone loss (CTIBL) should be considered by clinicians and recent guidelines should be routinely applied to these patients. In particular, baseline and periodic follow-up evaluations of bone health parameters enable the identification of patients at high risk of osteoporosis and fractures, which can be prevented by the use of bone-targeting agents (BTAs), calcium and vitamin D supplementation and modifications of lifestyle. This review will focus upon the pathophysiology of breast and prostate cancer treatment-induced bone loss and the most recent evidence about effective preventive and therapeutic strategies.
近几十年来,肿瘤学取得了重大进展,提高了患者的生存率,但也引发了人们对癌症治疗长期后果的担忧。在患有乳腺癌或前列腺癌的患者中,由于骨转移风险高,以及经常长期使用改变生理骨代谢的激素治疗,导致骨折风险增加,因此骨健康是一个主要问题。因此,临床医生应考虑癌症治疗引起的骨丢失(CTIBL),并且最近的指南应常规应用于这些患者。特别是,通过定期评估骨健康参数,可以确定处于骨质疏松症和骨折高风险的患者,通过使用骨靶向药物(BTAs)、钙和维生素 D 补充剂以及生活方式的改变,可以预防这些患者的骨丢失。这篇综述将重点介绍乳腺癌和前列腺癌治疗引起的骨丢失的病理生理学,以及关于有效预防和治疗策略的最新证据。