Tseng Olivia L, Spinelli John J, Gotay Carolyn C, Ho Wan Y, McBride Mary L, Dawes Martin G
Department of Family Practice, University of British Columbia, 3rd floor David Strangway Building, 5950 University Boulevard Building, Vancouver, BC V6T 1Z3, Canada.
Cancer Control Research Department, BC Cancer Research Centre, BC, Canada School of Population and Public Health, University of British Columbia, BC, Canada.
Ther Adv Musculoskelet Dis. 2018 Apr;10(4):71-90. doi: 10.1177/1759720X18759291. Epub 2018 Mar 22.
In this paper, our aim was to systematically evaluate published evidence of bone fracture risk associated with tamoxifen and aromatase inhibitors in women aged 65 and under, and diagnosed with nonmetastatic breast cancer.
We comprehensively searched MEDLINE, EMBASE and CINAHL databases from January 1997 through May 2015, and reference lists of the selected articles to identify English-language randomized controlled trials and cohort studies of fracture risk. Two independent reviewers screened articles and assessed methodological quality using Risk of Bias assessment for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies. Fracture risk was estimated as pooled risk ratios using a random-effects model and inverse variance method.
Of 1926 identified articles, 21 independent studies fulfilled our selection criteria. Similar fracture risk was observed in women treated and not treated with tamoxifen [pooled risk ratio (RR) 0.95; 95% confidence interval (CI) 0.84-1.07]. A 35% (95% CI 1.21-1.51) higher fracture risk was observed in the aromatase inhibitor group compared with the tamoxifen group. A 17% (95% CI 1.07-1.28) higher fracture risk was observed in the aromatase inhibitor group than the no aromatase inhibitor group. Compared with the tamoxifen group, aromatase inhibitor-associated fracture risk increased by 33% (pooled RR 1.33; 95% CI 1.21-1.47) during the tamoxifen/aromatase inhibitor treatment period, but did not increase (pooled RR 0.99; 95% CI 0.72-1.37) during the post-tamoxifen/aromatase inhibitor treatment period.
Fracture risk is significantly higher in women treated with aromatase inhibitors, especially during the treatment period. Tamoxifen is not associated with lower fracture risk while tamoxifen could potentially preserve bone mass. Better osteoporosis management programs, especially during the treatment period, are needed for this group of women.
在本文中，我们的目的是系统评估已发表的关于65岁及以下、被诊断为非转移性乳腺癌的女性使用他莫昔芬和芳香化酶抑制剂与骨折风险相关的证据。
我们全面检索了1997年1月至2015年5月的MEDLINE、EMBASE和CINAHL数据库，以及所选文章的参考文献列表，以识别关于骨折风险的英文随机对照试验和队列研究。两名独立评审员筛选文章，并使用随机对照试验的偏倚风险评估和队列研究的纽卡斯尔-渥太华量表评估方法学质量。使用随机效应模型和逆方差法将骨折风险估计为合并风险比。
在1926篇已识别的文章中，21项独立研究符合我们的选择标准。在接受和未接受他莫昔芬治疗的女性中观察到相似的骨折风险[合并风险比（RR）0.95；95%置信区间（CI）0.84 - 1.07]。与他莫昔芬组相比，芳香化酶抑制剂组的骨折风险高35%（95%CI 1.21 - 1.51）。与未使用芳香化酶抑制剂组相比，芳香化酶抑制剂组的骨折风险高17%（95%CI 1.07 - 1.28）。与他莫昔芬组相比，在他莫昔芬/芳香化酶抑制剂治疗期间，芳香化酶抑制剂相关的骨折风险增加了33%（合并RR 1.33；95%CI 1.21 - 1.47），但在他莫昔芬/芳香化酶抑制剂治疗后期间未增加（合并RR 0.99；95%CI 0.72 - 1.37）。
接受芳香化酶抑制剂治疗的女性骨折风险显著更高，尤其是在治疗期间。他莫昔芬与较低的骨折风险无关，而他莫昔芬可能有助于维持骨量。对于这组女性，需要更好的骨质疏松管理方案，尤其是在治疗期间。
