Background: Aromatase inhibitors (AIs) used in breast cancer induce loss in bone mineral density (BMD) and are reported to increase fracture risk.
Materials and methods: Using a population-based BMD registry, we identified women aged at least 40 years initiating AIs for breast cancer with at least 12 months of AI exposure (n = 1,775), women with breast cancer not receiving AIs (n = 1,016), and women from the general population (n = 34,205). Fracture outcomes were assessed to March 31, 2017 (mean, 6.2 years for AI users).
Results: At baseline, AI users had higher body mass index (BMI), higher BMD, lower osteoporosis prevalence, and fewer prior fractures than women from the general population or women with breast cancer without AI use (all p < .001). After adjusting for all covariates, AI users were not at significantly greater risk for major osteoporotic fractures (hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.93-1.42), hip fracture (HR, 0.90; 95% CI, 0.56-1.43), or any fracture (HR, 1.06; 95% CI, 0.88-1.28) compared with the general population.
Conclusion: Higher baseline BMI, BMD, and lower prevalence of prior fracture at baseline may offset the adverse effects of AI exposure. Although confirmatory data from large cohort studies are required, our findings challenge the view that all women with breast cancer initiating AI therapy should be considered at high risk for fractures.
Implications for practice: In a population-based observational registry that included 1,775 patients initiating long-term aromatase inhibitor therapy, risk for major osteoporotic fracture, hip fracture, or any fracture was similar to the general population. Higher baseline body mass index, bone mineral density, and lower prevalence of prior fracture at baseline may offset the adverse effects of aromatase inhibitor exposure.
关键词。骨质疏松症 • 乳腺癌 • 芳香化酶抑制剂 • 骨密度 • 骨折
摘要
背景。将芳香化酶抑制剂(AI)用于治疗乳腺癌可导致骨密度(BMD)降低，据报告，可增加骨折 风险。
材料和方法。我们采用基于人群的 BMD 登记，确定了年龄至少为 40 岁的开始接受 AI 治疗乳腺癌的女性，其 AI 暴露时间至少为 12 个月(n = 1 775)，患有乳腺癌但未接受 AI 治疗的女性(n = 1 016)，以及来自普通人群的女性(n = 34 205)。骨折结果评估至 2017 年 3 月 31 日(AI 使用者平均为 6.2 年)。
结果。基线情况下，与来自普通人群的女性或未使用 AI 的乳腺癌女性患者相比，AI 使用者具有更高的身体质量指数(BMI)，更高的 BMD，更低的骨质疏松症患病率和更低的骨折发生率(所有p < 0.001)。在对所有协变量进行校正后，AI 使用者发生严重骨质疏松性骨折 [风险比 (HR)，1.15；95% 置信区间 (CI)，0.93–1.42]、髋部骨折(HR，0.90；95% CI，0.56–1.43)或任何骨折(HR，1.06；95% CI，0.88–1.28)的风险均不显著高于一般人群。
结论。较高的基线 BMI、BMD 和较低的既往基线骨折发生率可抵消 AI 暴露的不良反应。尽管需要来自大型队列研究的证实性数据，但我们的研究结果对所有实施 AI 治疗的女性乳腺癌患者都应被视为骨折的高危人群这样的观点表示质疑。
实践意义:在一项基于人群的观察性登记中，包括 1 775 名实施长期芳香化酶抑制剂治疗的患者，其出现骨质疏松性骨折、髋部骨折或任何骨折的风险与普通人群相似。较高的基线身体质量指数、骨密度和较低的既往基线骨折发生率可抵消芳香化酶抑制剂暴露的不良反应。
Keywords: Aromatase inhibitors; Bone density; Breast cancer; Fracture; Osteoporosis.
© AlphaMed Press 2019.