Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele-Milan, Italy.
Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano-Milan, Italy.
Eur J Endocrinol. 2024 Aug 5;191(2):117-125. doi: 10.1093/ejendo/lvae086.
Bone health management in premenopausal women with breast cancer (BC) under hormone-deprivation therapies (HDTs) is often challenging, and the effectiveness of bone-active drugs is still unknown.
This retrospective multicenter study included 306 premenopausal women with early BC undergoing HDTs. Bone mineral density (BMD) and morphometric vertebral fractures (VFs) were assessed 12 months after HDT initiation and then after at least 24 months.
After initial assessment, bone-active drugs were prescribed in 77.5% of women (151 denosumab 60 mg/6 months, 86 bisphosphonates). After 47.0 ± 20.1 months, new VFs were found in 16 women (5.2%). Vertebral fracture risk was significantly associated with obesity (odds ratio [OR] 3.87, P = .028), family history of hip fractures or VFs (OR 3.21, P = .040], chemotherapy-induced menopause (OR 6.48, P < .001), preexisting VFs (OR 25.36, P < .001), baseline T-score less than or equal to -2.5 standard deviation (SD) at any skeletal site (OR 4.14, P = .036), and changes at lumbar and total hip BMD (OR 0.94, P = .038 and OR 0.88, P < .001, respectively). New VFs occurred more frequently in women untreated compared to those treated with bone-active drugs (14/69, 20.8% vs 2/237, 0.8%; P < .001) and the anti-fracture effectiveness remained significant after correction for BMI (OR 0.03; P < .001), family history of fractures (OR 0.03; P < .001), chemotherapy-induced menopause (OR 0.04; P < .001), and preexisting VFs (OR 0.01; P < .001).
Premenopausal women under HDTs are at high risk of VFs in relationship with high BMI, densitometric diagnosis of osteoporosis, preexisting VFs, and family history of osteoporotic fractures. Vertebral fractures in this setting might be effectively prevented by bisphosphonates or denosumab.
接受激素剥夺疗法（HDTs）的绝经前乳腺癌（BC）女性的骨骼健康管理通常具有挑战性，且骨活性药物的疗效仍不清楚。
本回顾性多中心研究纳入 306 例接受 HDTs 的绝经前早期 BC 女性。在 HDT 开始后 12 个月以及至少 24 个月后评估骨矿物质密度（BMD）和形态计量学椎体骨折（VF）。
初始评估后，77.5%（151 例 denosumab 60mg/6 个月，86 例双膦酸盐）的女性开始使用骨活性药物。47.0±20.1 个月后，16 例女性新发 VF（5.2%）。椎体骨折风险与肥胖显著相关（比值比 [OR] 3.87，P=.028）、髋部骨折或 VF 的家族史（OR 3.21，P=.040）、化疗引起的绝经（OR 6.48，P<.001）、预先存在的 VF（OR 25.36，P<.001）、任何骨骼部位的基线 T 评分≤-2.5 个标准差（SD）（OR 4.14，P=.036）以及腰椎和全髋 BMD 的变化（OR 0.94，P=.038 和 OR 0.88，P<.001）。与未接受骨活性药物治疗的女性相比，未治疗的女性新发 VF 更为常见（14/69，20.8%比 2/237，0.8%；P<.001），且在 BMI 校正后，抗骨折效果仍具有显著意义（OR 0.03；P<.001）、骨折家族史（OR 0.03；P<.001）、化疗引起的绝经（OR 0.04；P<.001）和预先存在的 VF（OR 0.01；P<.001）。
接受 HDTs 的绝经前女性 VF 风险较高，与高 BMI、骨密度诊断骨质疏松症、预先存在的 VF 和骨质疏松性骨折家族史有关。双膦酸盐或 denosumab 可有效预防此类患者的 VF。
