Department of Endocrinology, Christiaan Barnard Memorial Hospital, Cape Town, South Africa.
Department of Endocrinology, Kingsbury Hospital, Cape Town, South Africa.
Climacteric. 2022 Feb;25(1):67-72. doi: 10.1080/13697137.2021.1965117. Epub 2021 Aug 25.
Breast cancer is the most common cancer in women and the leading cause of cancer-associated mortality. The estrogen deprivation associated with therapies used to treat this disease may result in significant loss of bone density and a consequent increase in fracture risk. Anti-resorptive osteoporosis therapies (bisphosphonates and the inhibitor of receptor activator of nuclear factor-κB ligand [RANKL] denosumab) play an important role in the mitigation of cancer therapy-induced bone loss (CTIBL), and may function as adjuvant therapy in moderate to high-risk breast cancer to prevent disease recurrence. Various international guidelines have delineated treatment thresholds based on both bone density assessment and clinical risk factors for CTIBL. The role of these bone-targeted therapies as adjuvant anti-cancer treatment is evolving. Currently, evidence supports the use of the bisphosphonates, zoledronic acid and clodronate, in this setting. Unfortunately, a focus on bone health in women with breast cancer is often not prioritized, leaving this group vulnerable to significant bone loss and subsequent fracture.
乳腺癌是女性最常见的癌症，也是癌症相关死亡的主要原因。用于治疗这种疾病的疗法所导致的雌激素缺乏可能会导致骨密度显著下降，并随之增加骨折风险。抗吸收骨质疏松症疗法（双磷酸盐和核因子-κB 配体受体激活抑制剂[RANKL]地舒单抗）在减轻癌症治疗引起的骨丢失（CTIBL）方面发挥着重要作用，并且可能作为中度至高度乳腺癌的辅助治疗，以预防疾病复发。各种国际指南都根据骨密度评估和 CTIBL 的临床危险因素划定了治疗阈值。这些针对骨骼的治疗方法作为辅助抗癌治疗的作用正在不断发展。目前，有证据支持在这种情况下使用双磷酸盐、唑来膦酸和氯膦酸。不幸的是，关注乳腺癌女性的骨骼健康往往没有被优先考虑，使这一群体容易遭受严重的骨质流失和随后的骨折。
