Effect of Vitamin D on Bone Mineral Density Changes in Patients with Breast Cancer Receiving Adjuvant Aromatase Inhibitor Therapy
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: We assessed bone mineral density (BMD) changes with aromatase inhibitor (AI) treatment in women with breast cancer and determined whether BMD T-scores changed with vitamin D supplementation. Methods: This single-center, retrospective study included postmenopausal patients with breast cancer who had undergone surgical resection of stage I, II, or III estrogen- and/or progesterone-receptor-positive breast cancer and received adjuvant AIs (letrozole, anastrozole, and exemestane) at Kangbuk Samsung Hospital from January 2003 to July 2017. Baseline BMD T-scores of the femoral neck, proximal femur, and lumbar spine were obtained. The first group received vitamin D oral supplements (25,000 IU, monthly) or intravenous (IV) injections (200,000 IU, every 6 months). The second group did not receive vitamin D. T-scores were re-assessed at 12 and 24 months. BMD changes in the femoral neck, proximal femur, and lumbar spine were examined and compared according to vitamin D therapy. Results: A total of 118 women were included in the study. Eighty-four patients (71.2%) were aged >50 years, and most patients (64.1%) were postmenopausal. Group 1 (n=76, 64.4%) had received vitamin D oral supplements (25,000 IU, monthly) or IV injection (200,000 IU, every 6 months) during AI therapy. Group 2 (n=42, 35.6%) did not receive vitamin D during AI therapy. At baseline, 42.2% and 28.6% exhibited osteopenia at the femoral neck in Group 1 and Group 2, respectively. Both groups had T-score declines after AI therapy, with mean decreases of 0.23 and 0.41 at the femoral neck and lumbar spine, respectively, after 12 months and 0.40 and 0.55 at the femoral neck and lumbar spine, respectively, after 24 months in Group 1. However, differences in BMD T-score change at the femoral neck, total proximal femur, and lumbar spine between the groups were not statistically significant. Conclusion: Trends toward a decline in BMD in the femur and lumbar spine were observed in postmenopausal women with breast cancer receiving AI therapy. We did not observe a protective role of vitamin D supplementation against bone loss with AI therapy. A longer follow-up duration is necessary to determine whether vitamin D protects against bone loss during AI therapy.
Abstract
Purpose: We assessed bone mineral density (BMD) changes with aromatase inhibitor (AI) treatment in women with breast cancer and determined whether BMD T-scores changed with vitamin D supplementation. Methods: This single-center, retrospective study included postmenopausal patients with breast cancer who had undergone surgical resection of stage I, II, or III estrogen- and/or progesterone-receptor-positive breast cancer and received adjuvant AIs (letrozole, anastrozole, and exemestane) at Kangbuk Samsung Hospital from January 2003 to July 2017. Baseline BMD T-scores of the femoral neck, proximal femur, and lumbar spine were obtained. The first group received vitamin D oral supplements (25,000 IU, monthly) or intravenous (IV) injections (200,000 IU, every 6 months). The second group did not receive vitamin D. T-scores were re-assessed at 12 and 24 months. BMD changes in the femoral neck, proximal femur, and lumbar spine were examined and compared according to vitamin D therapy. Results: A total of 118 women were included in the study. Eighty-four patients (71.2%) were aged >50 years, and most patients (64.1%) were postmenopausal. Group 1 (n=76, 64.4%) had received vitamin D oral supplements (25,000 IU, monthly) or IV injection (200,000 IU, every 6 months) during AI therapy. Group 2 (n=42, 35.6%) did not receive vitamin D during AI therapy. At baseline, 42.2% and 28.6% exhibited osteopenia at the femoral neck in Group 1 and Group 2, respectively. Both groups had T-score declines after AI therapy, with mean decreases of 0.23 and 0.41 at the femoral neck and lumbar spine, respectively, after 12 months and 0.40 and 0.55 at the femoral neck and lumbar spine, respectively, after 24 months in Group 1. However, differences in BMD T-score change at the femoral neck, total proximal femur, and lumbar spine between the groups were not statistically significant. Conclusion: Trends toward a decline in BMD in the femur and lumbar spine were observed in postmenopausal women with breast cancer receiving AI therapy. We did not observe a protective role of vitamin D supplementation against bone loss with AI therapy. A longer follow-up duration is necessary to determine whether vitamin D protects against bone loss during AI therapy.
참고문헌 (22)
- Coombes RC, "Survival and safety of exemestane versus tamoxifen after 2-3 years’ tamoxifen treatment (intergroup exemestane study): a randomised controlled trial", Lancet, 369, pp.559~570 (2007)
- Crew KD, "Prevalence of joint symptoms in postmenopausal women taking aromatase inhibitors for early-stage breast cancer", J Clin Oncol, 25, pp.3877~3883 (2007)
- Ross AC, "Dietary reference intakes for calcium and vitamin D" (2011), National Academies Press
- Vieth R, "The urgent need to recommend an intake of vitamin D that is effective", Am J Clin Nutr, 85, pp.649~650 (2007)
- Runowicz CD, "American Cancer Society", American society of clinical oncology breast cancer survivorship care guideline, 2016, pp.34, 611~635
- Gralow JR, "NCCN task force report: bone health in cancer care", J Natl Compr Canc Netw, 11(Suppl 3), pp.S1~S50 (2013)
- Murad MH, "Clinical review: the effect of vitamin D on falls: a systematic review and meta-analysis", J Clin Endocrinol Metab, 96, pp.2997~3006 (2011)
- Dawson-Hughes B, "Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older", N Engl J Med, 337, pp.670~676 (1997)
- Kwan ML, "Changes in bone mineral density in women with breast cancer receiving aromatase inhibitor therapy", Breast Cancer Res Treat, 168, pp.523~530 (2018)
- Khan QJ, "Effect of vitamin D supplementation on serum 25-hydroxy vitamin D levels, joint pain, and fatigue in women starting adjuvant letrozole treatment for breast cancer", Breast Cancer Res Treat, 119, pp.111~118 (2010)
- Wang-Gillam A, "Evaluation of vitamin D deficiency in breast cancer patients on bisphosphonates", Oncologist, 13, pp.821~827 (2008)
- 방혜원, "한국 유방암 환자에서 혈청 1,25-Dihydroxyvitamin D 수치와 예후와의 관계에 대한 고찰", Journal of Breast Disease, 3(2), pp.37~42 (2015), 한국유방암학회[DOI]
- Eastell R, "Effect of anastrozole on bone mineral density: 5-year results from the anastrozole, tamoxifen, alone or in combination trial 18233230", J Clin Oncol, 26, pp.1051~1057 (2008)
- Vestergaard P, "Effect of tamoxifen and aromatase inhibitors on the risk of fractures in women with breast cancer", Calcif Tissue Int, 82, pp.334~340 (2008)
- Bergman GJ, "Efficacy of vitamin D3 supplementation in preventing fractures in elderly women: a meta-analysis", Curr Med Res Opin, 26, pp.1193~1201 (2010)
- Bischoff-Ferrari HA, "Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials", JAMA, 293, pp.2257~2264 (2005)
- Mizue Tanaka, "Effectiveness of bisphosphonate combined with activated vitamin D in patients with aromatase inhibitor-induced osteoporosis after breast cancer operation", Osteoporosis and Sarcopenia, 4(3), pp.102~108 (2018), 대한골다공증학회
- Prieto-Alhambra D, "Vitamin D threshold to prevent aromatase inhibitor-related bone loss: the B-ABLE prospective cohort study", Breast Cancer Res Treat, 133, pp.1159~1167 (2012)
- Rastelli AL, "Vitamin D and aromatase inhibitor-induced musculoskeletal symptoms (AIMSS): a phase II, double-blind, placebo-controlled, randomized trial", Breast Cancer Res Treat, 129, pp.107~116 (2011)
- Manson JE, "Vitamin D supplements and prevention of cancer and cardiovascular disease", N Engl J Med, 380, pp.33~44 (2019)
- Lappe J, "Effect of vitamin D and calcium supplementation on cancer incidence in older women: a randomized clinical trial", JAMA, 317, pp.1234~1243 (2017)
- Scragg R, "Monthly high-dose vitamin D supplementation and cancer risk: a post hoc analysis of the vitamin D assessment randomized clinical trial", JAMA Oncol, 4, pp.e182178~ (2018)