中国乳腺癌幸存者的椎体骨折：一项横断面研究，探讨患病率和卫生服务差距。
Vertebral fractures among breast cancer survivors in China: a cross-sectional study of prevalence and health services gaps.
机构信息
Section of Rheumatology, Yale School of Medicine, New Haven, CT, USA.
Department of Ultrasound, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
出版信息
BMC Cancer. 2018 Jan 30;18(1):104. doi: 10.1186/s12885-018-4014-5.
BACKGROUND
Breast cancer survivors are at high risk for fracture due to cancer treatment-induced bone loss, however, data is scarce regarding the scope of this problem from an epidemiologic and health services perspective among Chinese women with breast cancer.
METHODS
We designed a cross-sectional study comparing prevalence of vertebral fractures among age- and BMI-matched women from two cohorts. Women in the Breast Cancer Survivors cohort were enrolled from a large cancer hospital in Beijing. Eligibility criteria included age 50-70 years, initiation of treatment for breast cancer at least 5 years prior to enrollment, and no history of metabolic bone disease or bone metastases. Data collected included sociodemographic characteristics; fracture-related risk factors, screening and preventive measures; breast cancer history; and thoracolumbar x-ray. The matched comparator group was selected from participants enrolled in the Peking Vertebral Fracture Study, an independent cohort of healthy community-dwelling postmenopausal women from Beijing.
RESULTS
Two hundred breast cancer survivors were enrolled (mean age 57.5 ± 4.9 years), and compared with 200 matched healthy women. Twenty-two (11%) vertebral fractures were identified among breast cancer survivors compared with 7 (3.5%) vertebral fractures in the comparison group, yielding an adjusted odds ratio for vertebral fracture of 4.16 (95%CI 1.69-10.21, p < 0.01). The majority had early stage (85.3%) and estrogen and/or progesterone receptor positive (84.6%) breast cancer. Approximately half of breast cancer survivors reported taking calcium supplements, 6.1% reported taking vitamin D supplements, and only 27% reported having a bone density scan since being diagnosed with breast cancer.
CONCLUSIONS
Despite a four-fold increased odds of prevalent vertebral fracture among Chinese breast cancer survivors in our study, rates of screening for osteoporosis and fracture risk were low reflecting a lack of standardization of care regarding cancer-treatment induced bone loss.
背景
由于癌症治疗导致的骨质流失，乳腺癌幸存者骨折的风险很高，但是，从流行病学和卫生服务的角度来看，中国乳腺癌女性的这个问题的范围数据却很少。
方法
我们设计了一项横断面研究，比较了来自两个队列的年龄和 BMI 匹配的女性中椎骨骨折的患病率。乳腺癌幸存者队列中的女性是从北京一家大型癌症医院招募的。入选标准包括年龄在 50-70 岁之间、在入组前至少 5 年开始接受乳腺癌治疗、无代谢性骨病或骨转移史。收集的数据包括社会人口统计学特征；骨折相关危险因素、筛查和预防措施；乳腺癌病史；以及胸腰椎 X 线片。匹配的对照组是从北京参加北京椎体骨折研究的参与者中选择的，这是一个独立的健康社区绝经后女性队列。
结果
共纳入 200 名乳腺癌幸存者（平均年龄 57.5±4.9 岁），并与 200 名匹配的健康女性进行比较。在乳腺癌幸存者中发现 22 例（11%）椎骨骨折，而对照组中仅有 7 例（3.5%）椎骨骨折，调整后的椎骨骨折比值比为 4.16（95%CI 1.69-10.21，p<0.01）。大多数患者为早期（85.3%）和雌激素和/或孕激素受体阳性（84.6%）乳腺癌。约一半的乳腺癌幸存者报告服用钙补充剂，6.1%报告服用维生素 D 补充剂，只有 27%的人自被诊断出患有乳腺癌以来进行过骨密度扫描。
结论
尽管在我们的研究中，中国乳腺癌幸存者普遍存在椎骨骨折的风险增加了四倍，但骨质疏松症和骨折风险的筛查率却很低，这反映了针对癌症治疗引起的骨质流失的护理缺乏标准化。
Zotero 插件