Qunaj Lindor, Joffe Maureen, Neugut Alfred I, Micklesfield Lisa K
Division of Hematology/Oncology, Department of Medicine and Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY.
Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
JCO Glob Oncol. 2025 Jun;11:e2500122. doi: 10.1200/GO-25-00122. Epub 2025 Jun 18.
Worsening bone mineral density (BMD)-and the corresponding increase in osteoporotic fractures-is an important and well-established source of morbidity and mortality in women receiving treatment of breast cancer, as well as those living with HIV. However, there are comparatively few reports on pretreatment bone health in women newly diagnosed with breast cancer, especially in predominantly Black populations, across sub-Saharan Africa (SSA), and among individuals living with HIV. Therefore, we sought to characterize bone health in a cohort of Black South African women with and without HIV before the initiation of systemic breast cancer therapy, in particular chemotherapy and/or aromatase inhibitors.
Building on the South African Breast Cancer and HIV Outcomes study, we recruited consecutive women newly diagnosed with stage I-III breast cancer who were to start systemic cancer therapy at the Chris Hani Baragwanath Academic Hospital in Soweto, Johannesburg, between June 2021 and August 2024. In addition to collecting extensive demographic and clinical information, we conducted dual energy X-ray absorptiometry (DXA) scans on each patient to measure BMD of the lumbar spine, femoral neck, and total hip.
We enrolled a total of 378 women, 32.3% of whom (n = 122) were living with HIV. Among women aged 50 years and older (n = 156), 64.1% had osteopenia or osteoporosis; HIV infection and vitamin D insufficiency/deficiency-but no breast cancer characteristics-were associated with a higher risk of osteoporosis. By contrast, 3.6% of women younger than 50 years had BMD below the expected range for age.
Especially in low-resource clinical settings, such as public hospitals in SSA, understanding which women are at highest risk of osteoporosis and fragility fracture before the initiation of breast cancer systemic therapy is critical. Our study provides a foundation for identifying relevant risk factors and ultimately designing interventional studies that target high-risk women for intensified osteoporosis screening and management.
骨矿物质密度（BMD）恶化以及骨质疏松性骨折相应增加，是接受乳腺癌治疗的女性以及感染艾滋病毒的女性发病和死亡的重要且已明确的原因。然而，关于新诊断乳腺癌女性，尤其是撒哈拉以南非洲（SSA）主要为黑人的人群以及感染艾滋病毒的个体的治疗前骨骼健康的报告相对较少。因此，我们试图在一组患有和未患有艾滋病毒的南非黑人女性开始系统性乳腺癌治疗（特别是化疗和/或芳香化酶抑制剂）之前，对其骨骼健康进行特征描述。
基于南非乳腺癌与艾滋病毒结局研究，我们招募了2021年6月至2024年8月期间在约翰内斯堡索韦托的克里斯·哈尼·巴拉干纳特学术医院新诊断为I - III期乳腺癌且即将开始系统性癌症治疗的连续女性。除收集广泛的人口统计学和临床信息外，我们对每位患者进行了双能X线吸收测定（DXA）扫描，以测量腰椎、股骨颈和全髋的骨密度。
我们共纳入了378名女性，其中32.3%（n = 122）感染艾滋病毒。在50岁及以上的女性（n = 156）中，64.1%患有骨质减少或骨质疏松；艾滋病毒感染和维生素D不足/缺乏，但无乳腺癌特征，与骨质疏松风险较高相关。相比之下，50岁以下的女性中有3.6%的骨密度低于预期年龄范围。
特别是在资源匮乏的临床环境中，如SSA的公立医院，在开始乳腺癌系统性治疗之前了解哪些女性骨质疏松和脆性骨折风险最高至关重要。我们的研究为识别相关风险因素并最终设计针对高危女性进行强化骨质疏松筛查和管理的干预性研究奠定了基础。
