阿仑膦酸钠联合基础用药预防绝经女性乳腺癌术后依西美坦所致骨丢失的临床研究
Effect of alendronate in combination with basal medication on the prevention of exemestane-induced bone loss after breast cancer sur-gery in menopausal women
包利 1陈萌萌 1贾璞 1陈浩 1冯飞 1侍管 1唐海1
作者信息
- 1. 首都医科大学附属北京友谊医院骨科 北京 100050
- 折叠
摘要
目的 探讨阿仑膦酸钠联合基础用药预防绝经女性乳腺癌术后依西美坦所致骨丢失的临床疗效.方法 回顾性选取2018年6月至2022年6月于首都医科大学附属北京友谊医院因乳腺癌行依西美坦治疗、门诊根据骨密度结果诊断为骨量减少的绝经女性患者45例.根据治疗方案不同分为两组:联合用药组(n=24)和基础治疗组(n=21).联合用药组给予阿仑膦酸钠75 mg+钙+活性维生素D治疗,基础治疗组给予钙+活性维生素D治疗.比较两组患者治疗初始时、治疗后1年、治疗后2年的骨密度(腰椎骨密度、髋部骨密度);比较两组患者治疗初始时及治疗后2年的骨代谢指标,包括血清骨钙素、全段甲状旁腺素;并记录两组患者骨质疏松性骨折及泌尿系统结石的发生情况.结果 联合用药组患者治疗后1年及治疗后2年的腰椎及髋部骨密度较治疗初始时均无明显变化,差异均无统计学意义(P＞0.05);基础治疗组患者治疗后1年及治疗后2年的腰椎及髋部骨密度较治疗初始时均显著降低,差异均有统计学意义(P＜0.05).治疗初始时、治疗后1年,两组患者的腰椎及髋部骨密度比较,差异均无统计学意义(P＞0.05);治疗后2年,联合用药组腰椎及和髋部骨密度分别为-1.91±0.23、-1.93±0.31,均明显高于基础用药组(-2.21±0.30、-2.15±0.18),差异均有统计学意义(P＜0.05).联合用药组患者治疗后2年骨钙素和全段甲状旁腺素水平均较治疗初始时明显降低,差异均有统计学意义(P＜0.05);基础治疗组患者治疗后2年骨钙素水平较治疗初始时明显降低,差异有统计学意义(P＜0.05),而全段甲状旁腺素水平与治疗初始时比较,差异无统计学意义(P＞0.05).两组患者治疗初始时与治疗后2年骨钙素、全段甲状旁腺素比较,差异均无统计学意义(P＞0.05).两组患者治疗后2年内均无骨质疏松性骨折的发生,无泌尿系统结石的变化.结论 采用依西美坦治疗的乳腺癌术后患者,骨密度诊断骨量减少,早期应用阿仑膦酸钠,能够有效减缓骨流失的进程.
Abstract
Objective To clarify the clinical efficacy of alendronate application in patients taking exemestane after breast cancer surgery with bone loss.Methods A total of 45 menopausal female patients who underwent exemestane treatment for breast cancer from June 2018 to June 2022 and were diagnosed with bone loss based on bone mineral density in Beijing Friendship Hospital,Capital Medical University were retrospec-tive selected.They were divided into two groups according to the treatment strategies:the combination therapy group(n=24)and the basic treat-ment group(n=21).The combination therapy group was treated with alendronate sodium 75 mg+calcium+active vitamin D,while the basic treatment group was treated with calcium+active vitamin D.The bone density(lumbar spine bone density,hip bone density)of two groups of pa-tients at the beginning of treatment,after 1 year of treatment,and after 2 years of treatment were compared.The bone metabolism indicators of two groups of patients were compared at the beginning of treatment and 2 years after treatment,including serum osteocalcin and total parathyroid hor-mone.The occurrence of osteoporotic fractures and urinary system stones in two groups of patients was recorded.Results There were no statisti-cally significant differences in the bone density of the lumbar spine and hip in the combination therapy group after 1 year and 2 years of treatment compared to the beginning of treatment(P＞0.05);the bone density of the lumbar spine and hip in the basic treatment group after 1 year and 2 years of treatment were significantly lower than those of the beginning of treatment,and the differences were statistically significant(P＜0.05).At the beginning of treatment and one year after treatment,there were no statistically significant differences in bone density between the lumbar spine and hip of the two groups of patients(P＞0.05);after two years of treatment,the bone density of the lumbar spine and hip in the combina-tion therapy group was-1.91±0.23 and-1.93±0.31,respectively,which were significantly higher than those in the basic treatment group(-2.21±0.30 and-2.15±0.18),and the differences were statistically significant(P＜0.05).After 2 years of treatment,the levels of os-teocalcin and parathyroid hormone in the combination therapy group were significantly lower than those of the beginning of treatment,and the differ-ences were statistically significant(P＜0.05);after 2 years of treatment,the level of osteocalcin in the basic treatment group was significantly lower than that of the beginning of treatment,the difference was statistically significant(P＜0.05),while there were no statistically significant differences in the level of total parathyroid hormone compared to the initial stage of treatment(P＞0.05).There were no statistically significant differences in osteocalcin and total parathyroid hormone levels between the two groups of patients at the initial treatment,and after 2 years of treat-ment(P＞0.05).There was no occurrence of osteoporotic fracture and no change in urinary stones in both groups at 2 years follow-up.Con-clusion Postoperative breast cancer patients treated with exemestane,with bone mineral density diagnosis of bone loss,can effectively slow down the process of bone loss with early application of alendronate.
关键词
骨密度/骨质疏松/乳腺癌/依西美坦/骨量减少/阿仑膦酸钠Key words
Bone density/Osteoporosis/Breast cancer/Exemestane/Bone loss/Alendronate引用本文复制引用
基金项目
白求恩公益基金项目(G-X-2020-1107-3)
出版年
2024
NETL
NSTL
万方数据