Emerging bone health issues in women with breast cancer in Hawaii
Emerging bone health issues in women with breast cancer in Hawaii
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夏威夷乳腺癌女性新出现的骨骼健康问题
DOI：
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发表时间：
2007
期刊：
影响因子：
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通讯作者：
Jennifer B. Fu
中科院分区：
文献类型：
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作者：
Jennifer B. Fu
目的：芳香化酶抑制剂可改善激素受体阳性的绝经后早期乳腺癌患者的预后。芳香化酶抑制剂已经取代了先前的金标准治疗，他莫昔芬，一种选择性雌激素受体调节剂。然而，芳香化酶抑制剂显著降低雌二醇，并有可能增加骨质疏松症和相关骨折的风险。监测乳腺癌妇女骨骼健康的指导方针是存在的，但目前还不清楚这些建议是否是夏威夷的护理标准。本研究探讨了夏威夷早期乳腺癌妇女的辅助化疗和骨健康的相关问题。研究方法：这些患者是50岁及以上的早期乳腺癌妇女，她们服用芳香酶抑制剂或他莫昔芬，并在1999年至2006年期间在夏威夷最大的保险公司登记。他们的临床病史是从管理数据中获得的，包括他们以前使用激素替代疗法以及他们是否接受过放疗或辅助化疗。脊柱、髋关节和腕关节骨折、双膦酸盐治疗和双能X线吸收测量扫描是测量结果。结果：2006年，服用他莫昔芬的女性比例为29%，而服用芳香酶抑制剂的女性比例为71%。服用芳香化酶抑制剂的女性比服用他莫昔芬的女性更容易发生骨折（率比= 2.42）。更多服用芳香化酶抑制剂的患者接受骨密度扫描以及预防骨质流失的药物治疗（比值比= 1.86）。
Purpose: Aromatase inhibitors have improved breast cancer outcomes for early stage, postmenopausal women who have hormone receptor positive disease. Aromatase inhibitors have replaced the prior gold standard treatment, tamoxifen, a selective estrogen receptor modulator. However, aromatase inhibitors markedly reduce estradiol and have the potential to increase the risk for osteoporosis and associated bone fractures. Guidelines for monitoring bone health in women with breast cancer exist but it is unclear whether these recommendations are the standard of care in Hawaii. This study addresses adjuvant chemotherapy among women with early stage breast cancer and related issues of bone health in Hawaii. Methods: The patients were women age 50 and older with early stage breast cancer who were taking an aromatase inhibitor or tamoxifen and enrolled with the largest insurer in Hawaii from 1999 to 2006. Their clinical histories were obtained from administrative data including their prior use of hormone replacement therapy and whether they had received radiation or adjuvant chemotherapy. Spine, hip, and wrist fractures, bisphosphonate therapy, and dual energy X-ray absorptiometry scans were the measured outcomes. Results: In 2006, the percentage of women on tamoxifen was 29% compared to 71 % for aromatase inhibitors. Women taking aromatase inhibitors were significantly more likely to have bone fractures than those on tamoxifen (rate ratio=2.42). More patients on aromatase inhibitors received bone density scans as well as medications to prevent bone loss (odds ratio=1.86).