Effect of chemotherapy and different chemotherapy regimens on bone health among Chinese breast cancer women in different menstrual status: a self-control study

作者全名："Peng, Bai-qing; Wu, Juan; Tian, Shen; Qu, Xiu-quan; Liang, Xin-yu; Feng, Jun-han; Chen, Yu-ling; She, Rui-ling; Ma, Chen-yu; Song, Jing-yu; Li, Zhao-xing; Jiang, Zhi-yu; Wu, Kai-nan; Kong, Ling-quan"

作者地址："[Peng, Bai-qing; Wu, Juan; Tian, Shen; Qu, Xiu-quan; Liang, Xin-yu; Feng, Jun-han; Chen, Yu-ling; She, Rui-ling; Ma, Chen-yu; Song, Jing-yu; Li, Zhao-xing; Jiang, Zhi-yu; Wu, Kai-nan; Kong, Ling-quan] Chongqing Med Univ, Affiliated Hosp 1, Dept Endocrine & Breast Surg, Chongqing 400016, Peoples R China"

通信作者："Kong, LQ (通讯作者)，Chongqing Med Univ, Affiliated Hosp 1, Dept Endocrine & Breast Surg, Chongqing 400016, Peoples R China."

来源：SUPPORTIVE CARE IN CANCER

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001069654600001

JCR分区：Q1

影响因子：2.8

年份：2023

卷号：31

期号：9

开始页：　

结束页：　

文献类型：Article

关键词：Breast cancer; Chemotherapy; Bone health; Bone mineral density; Bone turnover markers; Bone metabolism; indicators

摘要："Purpose Although the therapy-related bone loss attracts increasing attention nowadays, the differences in chemotherapy-induced bone loss and bone metabolism indexes change among breast cancer (BC) women with different menstrual statuses or chemotherapy regimens are unknown. The aim of the study is to explore the effects of different regimens of chemotherapy on bone health. Method The self-control study enrolled 118 initially diagnosed BC women without distant metastasis who underwent dualenergy X-ray absorptiometry (DXA) bone mineral density (BMD) screening and (or) bone metabolism index monitoring during chemotherapy at Chongqing Breast Cancer Center. Mann-Whitney U test, Cochran's Q test, and Wilcoxon sign rank test were performed. Results After chemotherapy, the BMD in the lumbar 1-4 and whole lumbar statistically decreased (- 1.8%/per 6 months), leading to a significantly increased proportion of osteoporosis (27.1% vs. 20.5%, P < 0.05), which were mainly seen in the premenopausal group (- 7.0%/per 6 months). Of the chemotherapeutic regimens of EC (epirubicin + cyclophosphamide), TC (docetaxel + cyclophosphamide), TEC (docetaxel + epirubicin + cyclophosphamide), and EC-T(H) [epirubicin + cyclophosphamide-docetaxel and/ or trastuzumab], EC regimen had the least adverse impact on BMD, while the EC-TH regimen reduced BMD most (P < 0.05) inspite of the non-statistical difference between EC-T regimen, which was mainly seen in the postmenopausal group. Chemotherapy-induced amenorrhea (estradiol 94 pg/ml vs, 22 pg/ml; FSH 9.33 mIU/ml vs. 61.27 mIU/ml) was proved in premenopausal subgroup (P < 0.001). Except the postmenopausal population with calcium/VitD supplement, the albumin-adjusted calcium increased significantly (2.21 mmol/l vs. 2.33 mmol/l, P < 0.05) after chemotherapy. In postmenopausal group with calcium/VitD supplement, beta-CTX decreased significantly (0.56 ng/ml vs. 0.39 ng/ml, P < 0.05) and BMD were not affected by chemotherapy (P > 0. 05). In premenopausal group with calcium/VitD supplement, PTH decreased significantly (52.90 pg/ml vs. 28.80 pg/ml, P = 0. 008) and hip BMD increased after chemotherapy (0.845 g/m2 vs. 0.952 g/m(2), P = 0. 006). As for both postmenopausal and premenopausal group without calcium/VitD supplement, there was a significant decrease in bone mass in hip and lumbar vertebrae after chemotherapy (0.831 g/m(2) vs. 0.776 g/m(2); 0.895 g/m(2) vs. 0.870 g/m(2), P < 0.05). Conclusion Chemotherapy might induce lumbar vertebrae BMD loss and spine osteoporosis with regimen differences among Chinese BC patients. Calcium/VitD supplementation could improve bone turnover markers, bone metabolism indicators, and bone mineral density. Early interventions on bone health are needed for BC patients during chemotherapy."

基金机构：The authors gratefully acknowledge the support from the related hospitals and all the participants for their sharing of their datas in this study.

基金资助正文：The authors gratefully acknowledge the support from the related hospitals and all the participants for their sharing of their datas in this study.