مقاله انگلیسی رایگان در مورد متد های درمانی برای محافظت از سلامت استخوان در بیماران مبتلا به سرطان سینه – الزویر 2018

Survival for patients with breast cancer in Europe has improved substantially over the past three decades. Between 1989 and 1999, 5-year age-adjusted relative survival increased from 74% to 83% [1], and 5-year survival reached 82% for patients in whom breast cancer was diagnosed between 2000 and 2007 [2]. Recent agestandardized data from the United Kingdom predict 5-year survival of 86.6% for patients diagnosed between 2010 and 2011 [3]. Current levels of expectation for survival are due, in part, to the establishment of European breast cancer screening programmes and improved treatment options [4]. With increased survival comes a greater requirement for the long-term holistic care of patients than ever before [5]. Clinical experience of the long-term management of breast cancer has led to an appreciation of the importance of bone health throughout the disease course. The mean age at breast cancer diagnosis is 62 years [6], and because most patients are perimenopausal or postmenopausal women, they may already have experienced some osteopenic or osteoporotic bone loss. With the onset of menopause, declining oestrogen levels lead to a gradual decrease in bone mineral density (BMD) over time, with the potential for the development of postmenopausal osteoporosis [7]. A decrease in BMD may be exacerbated by the bone-destabilizing effects of certain cancer treatments used in early breast cancer, such as aromatase inhibitors, which can induce a menopause-equivalent state by reducing oestrogen levels, and some chemotherapies. This phenomenon is known as cancer treatment-induced bone loss (CTIBL) [8]. The rate of bone loss in women with breast cancer receiving aromatase inhibitors is at least twice that observed in healthy postmenopausal women [9]. In addition, more than 60% of women initiating chemotherapy are expected to experience ovarian failure within 1 year [10], which is associated with further significant and rapid declines in BMD [11]. Reductions in BMD cause skeletal weakening and increase the risk of pathologic fracture; indeed, the 3-year risk of vertebral fracture is almost fivefold greater in women with newly diagnosed breast cancer than in women in the general population [12]. It is important to note that, even in individuals with normal BMD, the risk of fracture in patients with breast cancer is high. For example, in the placebo arm of the Austrian Breast and Colorectal Cancer Study Group-18 (ABCSG18) trial in postmenopausal women with early-stage breast cancer, the incidence of pathologic fracture was 10% in individuals with normal BMD and 11% in those with low BMD [13].