A prospective study of lifestyle factors and bone health in breast cancer patients who received aromatase inhibitors in an integrated healthcare setting.
A prospective study of lifestyle factors and bone health in breast cancer patients who received aromatase inhibitors in an integrated healthcare setting.
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DOI：
10.1007/s11764-021-00993-0
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发表时间：
2023-03
期刊：
影响因子：
--
通讯作者：
Yao S
中科院分区：
文献类型：
--
作者：
Kwan ML;Lo JC;Laurent CA;Roh JM;Tang L;Ambrosone CB;Kushi LH;Quesenberry CP Jr;Yao S
骨折和骨质疏松症是芳香化酶抑制剂（AI）治疗绝经后激素受体阳性（HR+）乳腺癌（BC）患者的已知副作用。可改变的生活方式因素如何影响这些患者的骨折风险相对未知。我们进行了一项前瞻性队列研究，以检查2006-2013年在北方加州Kaiser Permanente诊断并接受AI的2，152名HR+ BC患者中生活方式因素（重点是体力活动）与重大骨质疏松性骨折和骨质疏松症风险的相关性。患者在进入研究和6个月随访时自我报告生活方式因素。骨折和骨质疏松症的结果分别由医生判定和骨矿物质密度（BMD）值进行前瞻性确定。根据多变量比例风险回归计算风险比（HR）和95%置信区间（CI）。根据年龄、绝经状态、人种/种族、体重指数（BMI）、AJCC分期、乳腺癌治疗、既往骨质疏松症和既往严重骨折调整模型。在AI开始后的平均6.1年随访中，165名女性发生了偶发性骨质疏松性骨折，243名女性患有骨质疏松症。总体中等强度的体力活动与骨折风险之间没有发现关联，尽管与≥150分钟/周（符合体力活动指南）相比，在BC诊断后6个月内<150分钟/周的有氧运动与骨折风险增加相关（HR=2.42; 95% CI：1.34，4.37）。从不或很少进行有氧运动的风险也较高（HR=1.90; 95%CI：1.05，3.44）。在BC诊断前6个月内没有或很少进行中度-剧烈体力活动与骨质疏松症风险增加相关（HR=1.94; 95%CI：1.11; 3.37）。在BC诊断后立即进行中等强度的体力活动，特别是有氧运动，与接受AI治疗的女性发生严重骨质疏松性骨折的风险较低相关。研究结果可以通过非药理学生活方式为基础的策略为AI治疗的女性预防骨折提供信息。
Fracture and osteoporosis are known side effects of aromatase inhibitors (AIs) for postmenopausal hormone receptor positive (HR+) breast cancer (BC) patients. How modifiable lifestyle factors impact fracture risk in these patients is relatively unknown. We conducted a prospective cohort study to examine the association of lifestyle factors, focusing on physical activity, with risk of incident major osteoporotic fracture and osteoporosis in 2,152 HR+ BC patients diagnosed from 2006–2013 at Kaiser Permanente Northern California and who received AIs. Patients self-reported lifestyle factors at study entry and at six-month follow-up. Fracture and osteoporosis outcomes were prospectively ascertained by physician-adjudication and bone mineral density (BMD) values, respectively. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated from multivariable proportional hazards regression. Models were adjusted for age, menopausal status, race/ethnicity, body mass index (BMI), AJCC stage, breast cancer treatment, prior osteoporosis, and prior major fracture. Over a median 6.1 years of follow-up after AI initiation, 165 women experienced an incident osteoporotic fracture and 243 women had osteoporosis. No associations were found between overall moderate-vigorous physical activity and fracture risk, although <150 minutes/week of aerobic exercise in the six months after BC diagnosis was associated with increased fracture risk (HR=2.42; 95% CI: 1.34, 4.37) compared to ≥150 minutes/week (meeting physical activity guidelines). Risk was also higher for never or infrequently engaging in aerobic exercise (HR=1.90; 95% CI: 1.05, 3.44). None or infrequent overall moderate-vigorous physical activity in the six months before BC diagnosis was associated with increased risk of osteoporosis (HR=1.94; 95% CI: 1.11; 3.37). Moderate-vigorous physical activity during the immediate period after BC diagnosis, particularly aerobic exercise, was associated with lower risk of major osteoporotic fractures in women on AI therapy. Findings may inform fracture prevention in women on AI therapy through non-pharmacologic lifestyle-based strategies.
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