Dan Med J. 2020 Oct 20;67(11):A04200223.
Adjuvant treatment of early-stage breast cancer has been associated with bone loss in randomised trials, but evidence from unselected populations is needed. In a single-center study, we assessed the annual percentage change in bone mineral density (∆BMDt) and risk of osteoporosis from two to five years after adjuvant chemotherapy in patients with oestrogen-receptor-positive and oestrogen-receptor-negative tumours.
Dual energy X-ray absorptiometry (DXA) was performed in 241 recurrence-free Danish breast cancer patients, among whom 157 had a prior DXA scan within two years of chemotherapy ("early"). Linear regression was used to assess ∆BMDt in spine and hip according to age, different health-related variables and time since early DXA.
Based on 157 patients, we observed annual decreases in spine BMD of 1.73% (95% confidence interval (CI): -2.01--1.44, p less than 0.001) and hip BMD of 1.30% (95% CI: -1.51--1.09, p less than 0.001). Patients aged less than 50 years at diagnosis had a significant decrease in mean spine BMD of 2.23% (95% CI: -2.78--1.68), whereas the decline was more limited in patients aged 50-59 years and patients aged 60 years or older with a mean spine BMD of 1.70% (95% CI: -2.07--1.34) and 0.81% (95% CI: -1.42--0.20), respectively. The results persisted in multivariable analyses. Osteoporosis was diagnosed in 9% of patients, all postmenopausal.
Adjuvant anthracycline-taxane-based chemotherapy followed by endocrine therapy caused bone loss, especially in younger compared with older patients with early-stage breast cancer, confirming the results from randomised trials.
This work was supported by the Region of Southern Denmark (grant number 13/7078); the University of Southern Denmark (grant number 00-101-000); the Danish Cancer Society (grant number R90-A6210-14-52); the Department of Oncology and Department of Endocrinology, Odense University Hospital; and the Consultant Council Scholarship, Odense University Hospital.
The study was approved by the Ethics Committee in Region of Southern Denmark (Project ID S-20140142) and the Danish Data Protection Board (ID 2008-58-0035).
随机试验表明，辅助治疗早期乳腺癌与骨丢失有关，但仍需要来自未选择人群的证据。在一项单中心研究中，我们评估了雌激素受体阳性和雌激素受体阴性肿瘤患者在接受辅助化疗后 2 至 5 年内，通过双能 X 射线吸收法（DXA）检测到的骨密度（BMD）年变化率（∆BMDt）和骨质疏松症的风险。
对 241 例丹麦无复发乳腺癌患者进行了 DXA 检测，其中 157 例在化疗前两年内进行了 DXA 检测（“早期”）。线性回归分析用于评估脊柱和髋部根据年龄、不同健康相关变量和早期 DXA 后时间的∆BMDt。
基于 157 例患者，我们观察到脊柱 BMD 每年下降 1.73%（95%置信区间（CI）：-2.01%--1.44%，p<0.001），髋部 BMD 每年下降 1.30%（95% CI：-1.51%--1.09%，p<0.001）。诊断时年龄小于 50 岁的患者平均脊柱 BMD 显著下降 2.23%（95% CI：-2.78%--1.68%），而年龄在 50-59 岁和 60 岁或以上的患者下降幅度较小，平均脊柱 BMD 分别为 1.70%（95% CI：-2.07%--1.34%）和 0.81%（95% CI：-1.42%--0.20%）。多变量分析结果一致。9%的患者被诊断为骨质疏松症，均为绝经后患者。
辅助蒽环类药物-紫杉烷类化疗联合内分泌治疗导致骨丢失，尤其是在早期乳腺癌的年轻患者中，这与随机试验的结果一致。
本工作得到南丹麦地区（资助号 13/7078）、南丹麦大学（资助号 00-101-000）、丹麦癌症协会（资助号 R90-A6210-14-52）、欧登塞大学医院肿瘤学系和内分泌学系以及欧登塞大学医院顾问委员会奖学金的支持。
该研究得到南丹麦地区伦理委员会（项目 ID S-20140142）和丹麦数据保护局（ID 2008-58-0035）的批准。
