Baek Han-Sang, Shin Kabsoo, Kim Jinyoung, Jeong Chaiho, Lee Jeongmin, Lim Yejee, Baek Ki-Hyun, Ha Jeonghoon
Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Division of Medical Oncology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
J Bone Miner Metab. 2024 Nov;42(6):720-727. doi: 10.1007/s00774-024-01552-0. Epub 2024 Sep 30.
Chemotherapy-induced bone loss (CTIBL) is common among breast cancer patients, requiring comprehensive assessment and intervention. Zoledronic acid, a strong inhibitor of bone resorption, is effective in CTIBL management, though information on dosing and intervals, particularly the efficacy of the 5 mg annual dose for osteoporosis in breast cancer patients, is limited.
In this 12-month prospective observational study, 85 breast cancer patients were divided into three groups: 17 received no treatment, 17 received tamoxifen, and 51 received anastrozole or letrozole (AI). Post-surgery, patients were administered a single 5 mg dose of zoledronic acid and monitored over 12 months for changes in bone mineral density (BMD), fracture rates, and biochemical markers.
Initially, the AI group was the oldest, averaging 59.1 ± 8.7 years. At baseline, no significant differences in variables, except age, were observed. After 12 months, BMD increased in all groups following a single zoledronic acid dose, with the smallest increase in the AI group at the lumbar spine: no treatment (2.4% ± 6.1%), tamoxifen (2.6% ± 3.4%), AI (0.6% ± 14.5%) (p = 0.778). CTx and P1NP levels were consistently suppressed up to 12 months post-treatment, with smaller reductions in the AI group. There were no significant differences in fracture or bone metastasis rates among groups.
A single infusion of 5 mg zoledronic acid was effective in increasing bone density in breast cancer patients. However, AI-treated patients showed less improvement in vertebral bone mineral density and biochemical markers. Further long-term studies with larger cohorts are needed.
化疗所致骨质流失（CTIBL）在乳腺癌患者中很常见，需要进行全面评估和干预。唑来膦酸是一种强效的骨吸收抑制剂，对CTIBL的治疗有效，不过关于给药剂量和间隔时间的信息，尤其是5毫克年度剂量对乳腺癌患者骨质疏松症的疗效，还很有限。
在这项为期12个月的前瞻性观察研究中，85例乳腺癌患者被分为三组：17例未接受治疗，17例接受他莫昔芬治疗，51例接受阿那曲唑或来曲唑（芳香化酶抑制剂）治疗。术后，患者接受单次5毫克剂量的唑来膦酸治疗，并在12个月内监测骨密度（BMD）、骨折率和生化指标的变化。
最初，芳香化酶抑制剂组患者年龄最大，平均年龄为59.1±8.7岁。在基线时，除年龄外，各变量均未观察到显著差异。12个月后，所有组在接受单次唑来膦酸剂量后骨密度均有所增加，其中芳香化酶抑制剂组在腰椎处的增加最小：未治疗组（2.4%±6.1%），他莫昔芬组（2.6%±3.4%），芳香化酶抑制剂组（0.6%±14.5%）（p = 0.778）。治疗后长达12个月，I型胶原交联C末端肽（CTx）和I型前胶原氨基端前肽（P1NP）水平持续受到抑制，芳香化酶抑制剂组的降低幅度较小。各组之间的骨折或骨转移率无显著差异。
单次输注5毫克唑来膦酸可有效增加乳腺癌患者的骨密度。然而，接受芳香化酶抑制剂治疗的患者在椎体骨密度和生化指标方面的改善较小。需要进一步开展更大样本量的长期研究。
