EFFECT OF WEIGHT LOSS ON BONE HEALTH IN POSTMENOPAUSAL BREAST CANCER SURVIVORS

描述(由申请人提供)：众所周知，减肥对骨骼健康有不利影响，特别是在绝经后的妇女中。一些研究表明，体力活动，特别是负重活动，可能会抵消骨质流失。考虑到与几种治疗方案相关的骨丢失，乳腺癌幸存者可能面临着骨健康不良的特别风险。关于减肥和锻炼对癌症幸存者骨骼健康的影响的研究有限。几项研究表明，锻炼可能会抵消乳腺癌幸存者的骨质流失，但这些研究并未包括减肥成分。鉴于能量限制是大多数成功的减肥方案的关键组成部分，了解它对绝经后乳腺癌幸存者的骨骼健康的作用是一个重要的安全考虑因素，因为绝经后乳腺癌患者的骨质丢失风险更高。能量试验(运动和营养促进恢复和健康)是一项先锋减肥试验，对象为n=800名21岁及以上患有IC-IIIA期乳腺癌的超重和肥胖妇女，涉及美国四个地点(RO1CA14879)。减肥主要是通过限制能量，同时强调有氧运动来补充减肥和促进减肥。因此，它为研究绝经后乳腺癌幸存者的体重变化和体力活动与骨丢失之间的关系提供了一个理想的环境。我们的主要假设是，在超重和肥胖的绝经后乳腺癌幸存者中，体重减轻和体力活动将与骨质丢失和重塑相关。我们将通过收集在圣路易斯(华盛顿大学医学院)进行能源试验的绝经后妇女(预计占200人的75%)的补充数据来检验这一点。这项研究的目的是描述主要减肥阶段(从随机到12个月)的骨丢失和骨重建的特征。我们的建议是创新的，因为这将是第一项前瞻性地评估有目的的减肥和减肥期间的体力活动对超重和肥胖的绝经后乳腺癌幸存者的骨骼健康的影响的研究。这一点意义重大，因为考虑到肥胖对这一人群的发病率和死亡率的不利影响，人们非常关注乳腺癌幸存者体重管理的必要性。有关骨密度的结果可以直接为乳腺癌后妇女的临床实践和建议提供信息。具体地说，我们的目标是在参加随机对照减肥试验的超重和肥胖的绝经后乳腺癌患者中，测量体重变化与体力活动和骨丢失之间的相关性，其次，描述体重变化和体力活动之间的相互作用与骨丢失的关系。

DESCRIPTION (provided by applicant): Weight loss is known to have adverse consequences for bone health, particularly in postmenopausal women. Some research has indicated that physical activity, particularly weight-bearing activity, may offset bone loss. Breast cancer survivors may be at particular risk for adverse bone health given the bone loss associated with several treatment regimens. There is limited research on the effects of weight loss and exercise on bone health in cancer survivors. Several studies have suggested that exercise may offset bone loss in breast cancer survivors, but these studies have not included a weight loss component. Given that energy restriction is a key component to most successful weight loss regimens, understanding the role it has on bone health in postmenopausal breast cancer survivors, who are at increased risk for bone loss, is an important safety consideration. The ENERGY trial (Exercise and Nutrition to Enhance Recovery and Good health for You) is a vanguard weight loss trial of n=800 overweight and obese women age 21 and older with stage IC-IIIA breast cancer across four sites in the US (RO1CA14879). Weight loss is achieved primarily through energy restriction with concurrent emphasis on aerobic exercise to complement weight loss and promote maintenance of weight loss. Thus, it provides an ideal setting to examine the associations between weight change and physical activity with bone loss in postmenopausal breast cancer survivors. Our primary hypothesis is that weight loss and physical activity will be correlated with bone loss and remodeling among overweight and obese postmenopausal breast cancer survivors. We will examine this through the collection of supplementary data in the postmenopausal women (expected to be 75% of the n=200) enrolled in the ENERGY trial at the St. Louis site (at Washington University School of Medicine). The goal of this study is to characterize bone loss and remodeling during the primary weight loss phase (from randomization to 12 months). Our proposal is innovative in that it will be the first study to prospectively assess the effects of intentional weight loss and physical activity during weight loss, independently and together, on bone health in overweight and obese postmenopausal breast cancer survivors. This is significant as there is great attention to the need for weight management in breast cancer survivors given the adverse effects of obesity on morbidity and mortality in this population. Results on bone density can directly inform clinical practice and recommendations for women after breast cancer. Specifically, our aims are to measure the correlation between weight change and physical activity and bone loss among overweight and obese postmenopausal breast cancer survivors enrolled in a randomized controlled weight loss trial and, secondarily, to characterize the interaction between weight change and physical activity as it relates to bone loss.