EFFECTS OF TAMOXIFEN ON BONE-MINERAL DENSITY IN POSTMENOPAUSAL WOMEN WITH BREAST-CANCER
EFFECTS OF TAMOXIFEN ON BONE-MINERAL DENSITY IN POSTMENOPAUSAL WOMEN WITH BREAST-CANCER
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DOI：
10.1056/nejm199203263261302
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发表时间：
1992-03-26
影响因子：
158.5
通讯作者：
DEMETS, DL
中科院分区：
文献类型：
--
作者：
LOVE, RR;MAZESS, RB;DEMETS, DL
背景和方法。 他莫昔芬是一种合成的抗雌激素药物，当用作原发性乳腺癌的辅助治疗时，可以增加无病生存率和总生存率。因为它是长期服用的，所以了解它莫西芬是否会影响骨骼是很重要的，特别是因为它被广泛用于绝经后妇女谁是骨质疏松症的风险。采用光子吸收法，我们研究了他莫昔芬对140例腋淋巴结阴性乳腺癌绝经后妇女腰椎和桡骨骨密度以及骨代谢生化指标的影响，该研究为期两年，随机、双盲、安慰剂对照。 在服用他莫昔芬的妇女中，腰椎的平均骨密度每年增加0.61%，而服用安慰剂的妇女每年减少1.00%（P < 0.001）。两组桡骨骨密度下降程度相同。在每组随机选择的一个亚组中，服用他莫昔芬的妇女血清骨钙素和碱性磷酸酶浓度显著降低（每个变量P < 0.001），而血清甲状旁腺激素和1，25-二羟维生素D浓度在两组中均无显著变化。 在绝经后妇女中，他莫昔芬治疗与腰椎骨密度的保护有关。这种对骨密度的有利影响是否伴随着骨折风险的降低仍有待确定。
Background and Methods. Tamoxifen, a synthetic antiestrogen, increases disease-free and overall survival when used as adjuvant therapy for primary breast cancer. Because it is given for long periods, it is important to know whether tamoxifen affects the skeleton, particularly since it is used extensively in postmenopausal women who are at risk for osteoporosis. Using photon absorptiometry, we studied the effects of tamoxifen on the bone mineral density of the lumbar spine and radius and on biochemical measures of bone metabolism in 140 postmenopausal women with axillary-node-negative breast cancer, in a two-year randomized, double-blind, placebo-controlled trial.Results. In the women given tamoxifen, the mean bone mineral density of the lumbar spine increased by 0.61 percent per year, whereas in those given placebo it decreased by 1.00 percent per year (P < 0.001). Radial bone mineral density decreased to the same extent in both groups. In a subgroup randomly selected from each group, serum osteocalcin and alkaline phosphatase concentrations decreased significantly in women given tamoxifen (P < 0.001 for each variable), whereas serum parathyroid hormone and 1,25-dihydroxyvitamin D concentrations did not change significantly in either group.Conclusions. In postmenopausal women, treatment with tamoxifen is associated with preservation of the bone mineral density of the lumbar spine. Whether this favorable effect on bone mineral density is accompanied by a decrease in the risk of fractures remains to be determined.