Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG.
Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG.
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激素敏感性乳腺癌绝经后妇女芳香化酶抑制剂相关骨丢失（Aibl）的管理：IOF、CABS、ECTS、IEG、ESCEO IMS和SIOG的联合立场声明。
DOI：
10.1016/j.jbo.2017.03.001
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发表时间：
2017-06
影响因子：
3.4
通讯作者：
Coleman RE
中科院分区：
文献类型：
--
作者：
Hadji P;Aapro MS;Body JJ;Gnant M;Brandi ML;Reginster JY;Zillikens MC;Glüer CC;de Villiers T;Baber R;Roodman GD;Cooper C;Langdahl B;Palacios S;Kanis J;Al-Daghri N;Nogues X;Eriksen EF;Kurth A;Rizzoli R;Coleman RE
已经报道了几个针对早期乳腺癌（EBC）女性的骨导向治疗指南，以避免骨折，特别是在芳香酶抑制剂（AI）治疗期间。最近，一些关于其他骨折相关风险因素的研究、新的治疗选择以及真实的世界研究表明，骨折发生率远高于随机临床对照试验（RCT）。因此，开发这种更新的算法是为了更好地评估骨折风险和指导治疗，作为参与人工智能相关骨质流失（Aibl）管理的几个跨学科癌症和骨骼协会的立场声明。一项系统的文献综述确定了Aibl管理的最新进展。根据试验设计、规模、随访和安全性评估了单个药物的结果。确定了EBC患者的几个骨折相关危险因素。尽管FRAX算法除了BMD外还包括骨折风险因素（RF），但似乎无法充分解决Aibl的影响。几种抗吸收剂可以预防和治疗Aibl。然而，对合规性和长期安全性的担忧仍然存在。总体而言，Denosumab 60 mg s.c.预防骨折的证据最强。每6个月。此外，最近的研究以及所有可用随机试验数据的个体患者数据荟萃分析支持绝经后妇女辅助双膦酸盐治疗的额外抗癌益处，骨转移相对风险降低34%，乳腺癌死亡率相对风险降低17%，在建议Aibl管理时需要考虑。在所有开始AI治疗的患者中，应评估骨折风险，并建议进行运动和补充钙/维生素D。对于所有T评分<-2.0或T评分<-1.5 SD且有一个额外RF或在AI治疗期间有≥2个风险因素（无BMD）的患者，应给予骨导向治疗。对于T评分>-1.5 SD且无危险因素的患者，应根据第一年的BMD损失和当地绝经后骨质疏松症指南进行管理。治疗12 - 24个月后，应定期评估依从性以及BMD。此外，由于骨复发率和乳腺癌特异性死亡率降低，因此建议所有有显著疾病复发风险的绝经后妇女使用辅助性双膦酸盐。
Several guidelines have been reported for bone-directed treatment in women with early breast cancer (EBC) for averting fractures, particularly during aromatase inhibitor (AI) therapy. Recently, a number of studies on additional fracture related risk factors, new treatment options as well as real world studies demonstrating a much higher fracture rate than suggested by randomized clinical controlled trials (RCTs). Therefore, this updated algorithm was developed to better assess fracture risk and direct treatment as a position statement of several interdisciplinary cancer and bone societies involved in the management of AI-associated bone loss (AIBL). A systematic literature review identified recent advances in the management of AIBL. Results with individual agents were assessed based on trial design, size, follow-up, and safety. Several fracture related risk factors in patients with EBC were identified. Although, the FRAX algorithm includes fracture risk factors (RF) in addition to BMD, it does not seem to adequately address the effects of AIBL. Several antiresorptive agents can prevent and treat AIBL. However, concerns regarding compliance and long-term safety remain. Overall, the evidence for fracture prevention is strongest for denosumab 60 mg s.c. every 6 months. Additionally, recent studies as well as an individual patient data meta-analysis of all available randomized trial data support additional anticancer benefits from adjuvant bisphosphonate treatment in postmenopausal women with a 34% relative risk reduction in bone metastasis and 17% relative risk decrease in breast cancer mortality that needs to be taken into account when advising on management of AIBL. In all patients initiating AI treatment, fracture risk should be assessed and recommendation with regard to exercise and calcium/vitamin D supplementation given. Bone-directed therapy should be given to all patients with a T-score<−2.0 or with a T-score of <–1.5 SD with one additional RF, or with ≥2 risk factors (without BMD) for the duration of AI treatment. Patients with T-score>−1.5 SD and no risk factors should be managed based on BMD loss during the first year and the local guidelines for postmenopausal osteoporosis. Compliance should be regularly assessed as well as BMD on treatment after 12 - 24 months. Furthermore, because of the decreased incidence of bone recurrence and breast cancer specific mortality, adjuvant bisphosphonates are recommended for all postmenopausal women at significant risk of disease recurrence.