Guidance for the management of breast cancer treatment-induced bone loss: A consensus position statement from a UK Expert Group
Guidance for the management of breast cancer treatment-induced bone loss: A consensus position statement from a UK Expert Group
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DOI：
10.1016/j.ctrv.2008.03.007
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发表时间：
2008-01-01
影响因子：
11.8
通讯作者：
Coleman, Robert E.
中科院分区：
文献类型：
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作者：
Reid, David M.;Doughty, Julie;Coleman, Robert E.
在绝经后妇女中，芳香酶抑制剂的使用增加了骨转换，并以平均每年1-3%的速度在富含骨小梁的部位引起骨丢失，导致骨折发生率比使用他莫昔芬期间增加。骨质流失在接受芳香酶抑制剂治疗后的卵巢抑制治疗的年轻女性中更为明显（平均每年7-8%）。他莫昔芬预处理2-5年可能会降低与芳香酶抑制剂相关的不良骨效应的临床意义，特别是如果这导致芳香酶抑制剂暴露时间的缩短。然而，骨骼状况仍应在芳香酶抑制剂治疗开始时进行评估。在45岁之前经历过早绝经或正在接受卵巢抑制治疗的妇女中，同时使用芳香酶抑制剂会加速骨质疏松的发生率。这些患者被认为具有临床上重要的骨抛掷的高风险，应该进行基线双能x线骨密度（DXA）评估。绝经后妇女的随机临床试验表明，双膦酸盐可以预防芳香酶抑制剂治疗相关的骨质流失和加速骨转换，是预防和治疗骨质疏松症的一种有希望的策略。治疗开始的建议是基于骨质疏松性骨折和骨密度水平的危险因素的组合。双膦酸盐、健康的生活方式以及摄入足够的钙和维生素D是预防骨质流失的首选治疗方法。由于与乳腺癌治疗相关的骨质疏松率，以及芳香酶抑制剂使用与骨密度之间的相互作用对骨折风险的不确定性，干预的阈值已被设定为高于绝经后骨质疏松症的一般推荐水平。管理建议总结为两种算法，一种用于经历过早绝经的妇女，另一种用于需要辅助芳香酶抑制剂治疗的绝经后妇女。(c) 2008 Elsevier Ltd.版权所有。
In postmenopausal women, the use of aromatase inhibitors increases bone turnover and induces bone loss at sites rich in trabecular bone at an average rate of 1-3% per year leading to an increase in fracture incidence compared to that seen during tamoxifen use. The bone Loss is much more marked in young women with treatment-induced ovarian suppression followed by aromatase inhibitor therapy (average 7-8% per annum). Pre-treatment with tamoxifen for 2-5 years may reduce the clinical significance of the adverse bone effects associated with aromatase inhibitors, particularly if this leads to a shortening in the duration of exposure to an aromatase inhibitor. However, skeletal status should stilt be assessed at the commencement of aromatase inhibitor therapy. The rate of bone toss in women who experience a premature menopause before the age of 45 or are receiving ovarian suppression therapy is accelerated by the concomitant use of aromatase inhibitors. These patients are considered to be at high risk of clinically important bone toss and should have a baseline dual energy Xray absorptiometry (DXA) assessment of bone mineral density (BMD).Randomised clinical trials in postmenopausal women indicate that bisphosphonates prevent the bone loss and accelerated bone turnover associated with aromatase inhibitor therapy and are a promising strategy for the prevention and treatment of osteoporosis in this setting. Treatment initiation recommendations are based on a combination of risk factors for osteoporotic fracture and BMD levels. Bisphosphonates, along with a healthy lifestyle and adequate intake of calcium and vitamin D are the treatments of choice to prevent bone loss. Due to the rate of bone toss associated with breast cancer treatments, and uncertainties about the interaction between aromatase inhibitor use and BMD for fracture risk, the threshold for intervention has been set at a higher level than that generally recommended for postmenopausal osteoporosis.Management recommendations have been summarised in two algorithms, one for women experiencing a premature menopause and the other for postmenopausal women requiring adjuvant aromatase inhibitor therapy. (c) 2008 Elsevier Ltd. All rights reserved.