Bone loss and fracture risk associated with cancer therapy
Bone loss and fracture risk associated with cancer therapy
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DOI：
10.1634/theoncologist.11-10-1121
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发表时间：
2006-01-01
期刊：
影响因子：
5.8
通讯作者：
Guise, Theresa A.
中科院分区：
文献类型：
--
作者：
Guise, Theresa A.
背景。癌症患者因治疗导致骨矿物质密度 (BMD) 加速丧失而导致骨质疏松。这种骨质流失大大增加了骨折的风险，并对生活质量产生其他严重影响。方法。在本报告中，作者重点研究了癌症治疗相关的骨质流失、其患病率和发病机制以及由此产生的临床影响。还审查了管理和预防的选择，包括可用的治疗指南。结果。多种癌症疗法，包括激素疗法、化疗和糖皮质激素，都会影响性腺激素的产生，从而增加骨吸收并降低 BMD。与正常的年龄相关骨质疏松症相比，这种骨质流失发生得更快、程度更大，增加了骨折和其他疾病的风险，并降低了生存率。定期骨密度筛查和早期干预可以防止骨密度和骨质量进一步下降。口服和静脉注射药物治疗双磷酸盐已被证明可以减缓接受癌症治疗的患者的骨质流失，并且静脉注射。双膦酸盐唑来膦酸可以增加癌症治疗相关骨质流失患者的 BMD。生活方式的改变，包括补充钙和维生素 D、饮食和适当的运动，也可以减缓骨质流失的速度。结论。与各种癌症治疗相关的骨质流失显着影响骨骼健康。如有需要，尽早开始使用双磷酸盐以及改变生活方式可以改善患者的预后。对患者和医疗保健专业人员进行有关这种并发症的重要性和有效治疗方案的教育至关重要。
Background. Cancer patients experience osteoporosis resulting from accelerated loss of bone mineral density (BMD) caused by their treatment. Such bone loss greatly increases the risk for fracture and can have other serious effects on quality of life.Methods. In the current report, the author focuses on studies of cancer therapy-associated bone loss, its prevalence and pathogenesis, and resulting clinical impact. Options for management and prevention are also reviewed, including treatment guidelines where available.Results. A variety of cancer therapies, including hormonal therapy, chemotherapy, and glucocorticoids, affect gonadal hormone production, which increases bone resorption and decreases BMD. Such bone loss occurs more rapidly and to a greater degree than normal age-related osteoporosis, increases the risk for fracture and other morbidities, and decreases survival. Regular BMD screening and early intervention can prevent further decline in bone density and bone quality. Pharmacologic therapy with oral and i.v. bisphosphonates has been shown to slow bone loss in patients receiving cancer therapy, and the i.v. bisphosphonate zoledronic acid can increase BMD in patients with cancer treatment-related bone loss. Lifestyle changes, including supplementation with calcium and vitamin D, diet, and proper exercise, can also slow the rate of bone loss.Conclusions. Bone loss associated with various cancer therapies significantly affects bone health. Early initiation of bisphosphonates, when indicated, and lifestyle modification can improve patient outcomes. Education of patients and health care professionals regarding the importance of this complication and effective treatment options is essential.