Rouach Vanessa, Greenman Yona, Chodick Gabriel, Goldshtein Inbal
Institute of Endocrinology, Diabetes, Hypertension and Metabolism, Sourasky Medical Center, Tel Aviv, Israel.
Epidemiology Department, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel.
J Bone Oncol. 2023 Aug 25;42:100501. doi: 10.1016/j.jbo.2023.100501. eCollection 2023 Oct.
Several guidelines have been proposed to prevent aromatase inhibitors induced bone loss (AIBL), but there is scarce data on their endorsement in clinical practice.
To assess bone health evaluation and fracture prevention in postmenopausal women with estrogen receptor (ER)-positive breast cancer after aromatase inhibitors (AI) initiation.
An historical cohort analysis based on data from the cancer and osteoporosis Maccabi Health Services (MHS) registries from Jan 1st 2009 to Dec 31st 2020. Cases of estrogen receptor (ER)-positive breast cancer were extracted. Index date was set as the first aromatase inhibitors (AI) purchase. Variables such as age, BMI, smoking history, alcohol use, rheumatoid arthritis, diabetes, glucocorticosteroid use, previous fractures, BMD T-scores and purchases of AI and anti-resorptive agents were collected. Age under 50, previous cancer, prior major osteoporotic fractures and prior anti-resorptive treatment were exclusion criteria. Kaplan-Meier curves were generated to assess the time to outcomes. Multivariable Cox's proportional hazards survival model was performed.
A total of 8617 women initiating AI were eligible. The median follow up was 6.1 years. The mean (SD) age at index was 62.8 (9.2), the mean (SD) BMI was 29.1 (5.6). The mean (SD) T-score was -1.3 (1.2) at the lumbar spine, -1.5 (0.9) at the femoral neck and -1.0 (1.0) at the total hip. Twenty percent had type 2 diabetes, 8.1 % were active smokers, 3.8% had rheumatoid arthritis and 1.2% were exposed to glucocorticoids.A total of 37% and 53% underwent a DXA scan at 1 and 2 years from AI initiation, and 12% and 17% were prescribed an anti-resorptive agent at 1 and 2 years from index. Advanced age was associated with a higher rate of evaluation and treatment, while obesity and diabetes were associated with a lower rate. The cumulative incidence of a major osteoporotic fracture was 8.8 and 15.8 % at 5 and 10 years, respectively.
Despite the excess risk of fractures, bone health assessment and preventive treatment are still partial and postponed in breast cancer AI treated patients. Strategies to ensure appropriate care are needed.
已经提出了多项指南来预防芳香化酶抑制剂引起的骨质流失（AIBL），但关于它们在临床实践中得到认可的数据却很少。
评估绝经后雌激素受体（ER）阳性乳腺癌患者在开始使用芳香化酶抑制剂（AI）后的骨骼健康评估和骨折预防情况。
基于2009年1月1日至2020年12月31日癌症与骨质疏松症马卡比健康服务（MHS）登记处的数据进行历史队列分析。提取雌激素受体（ER）阳性乳腺癌病例。索引日期设定为首次购买芳香化酶抑制剂（AI）的日期。收集年龄、体重指数、吸烟史、饮酒情况、类风湿性关节炎、糖尿病、糖皮质激素使用情况、既往骨折情况、骨密度T值以及AI和抗吸收剂的购买情况等变量。年龄在50岁以下、既往有癌症、既往有严重骨质疏松性骨折和既往接受过抗吸收治疗为排除标准。生成Kaplan-Meier曲线以评估达到结局的时间。进行多变量Cox比例风险生存模型分析。
共有8617名开始使用AI的女性符合条件。中位随访时间为6.1年。索引时的平均（标准差）年龄为62.8（9.2）岁，平均（标准差）体重指数为29.1（5.6）。腰椎的平均（标准差）T值为-1.3（1.2），股骨颈为-1.5（0.9），全髋为-1.0（1.0）。20% 的患者患有2型糖尿病，8.1% 为现吸烟者，3.8% 患有类风湿性关节炎，1.2% 曾接触糖皮质激素。从开始使用AI起1年和2年时，分别有37% 和53% 的患者接受了双能X线吸收法（DXA）扫描，从索引日期起1年和2年时，分别有12% 和17% 的患者被处方了抗吸收剂。高龄与更高的评估和治疗率相关，而肥胖和糖尿病与更低的评估和治疗率相关。严重骨质疏松性骨折的累积发生率在5年和10年时分别为8.8% 和15.8%。
尽管骨折风险增加，但在接受AI治疗的乳腺癌患者中，骨骼健康评估和预防性治疗仍然不全面且延迟。需要采取策略以确保提供适当的护理。
