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Abstract：
OBJECTIVE: In patients with postmenopausal hormone receptor-positive breast cancer (ER + eBC), aromatase inhibitors (AIs) are widely used for effective relapse prevention. However, AIs reduce bone density and increase bone-related events (BREs). Alongside calcium and vitamin D3 supplementation, bisphosphonates and denosumab are well-known options for improving outcomes in bone health and breast cancer prognosis. This study aimed to evaluate the practice patterns of bone health guideline-based management in real-world patients with ER + eBC.
METHODS: In total, 68 patients with ER + eBC treated between 2009 and 2014 at the University Hospital Basel were included in this retrospective cohort study. Chart reviews were analyzed. Baseline, clinicopathological, treatment, and BRE data were extracted. Each patient was specifically reviewed for therapy adherence to the Swiss bone health guidelines (Swiss Association against Osteoporosis 2010 [SVGO]).
RESULTS: The mean patient age was 66.5 (range, 56-74) years, all post-menopausal. The most frequent tumor characteristics were tumor size of pT1-pT2 (N = 53, 77.9%) and treatment with letrozole (N = 35, 51.5%), followed by tamoxifen as a switch strategy (N = 27, 40.3%). The median treatment time with AIs was 47 (range, 30-60) months. Five patients (7.8%) experienced a fracture during or after AI treatment. Moreover, 51 (75%) patients were treated according to the SVGO recommendations.
CONCLUSIONS: The fracture rate in our retrospective cohort was comparable to that in the larger phase III randomized trials. The adherence to bone health guidelines was satisfactory but still suboptimal. Clinicians should strictly adhere to the current bone health guidelines to ensure the best possible prevention of BREs and maintain bone health and cancer prognosis in patients with ER + eBC.
METHODS: In total, 68 patients with ER + eBC treated between 2009 and 2014 at the University Hospital Basel were included in this retrospective cohort study. Chart reviews were analyzed. Baseline, clinicopathological, treatment, and BRE data were extracted. Each patient was specifically reviewed for therapy adherence to the Swiss bone health guidelines (Swiss Association against Osteoporosis 2010 [SVGO]).
RESULTS: The mean patient age was 66.5 (range, 56-74) years, all post-menopausal. The most frequent tumor characteristics were tumor size of pT1-pT2 (N = 53, 77.9%) and treatment with letrozole (N = 35, 51.5%), followed by tamoxifen as a switch strategy (N = 27, 40.3%). The median treatment time with AIs was 47 (range, 30-60) months. Five patients (7.8%) experienced a fracture during or after AI treatment. Moreover, 51 (75%) patients were treated according to the SVGO recommendations.
CONCLUSIONS: The fracture rate in our retrospective cohort was comparable to that in the larger phase III randomized trials. The adherence to bone health guidelines was satisfactory but still suboptimal. Clinicians should strictly adhere to the current bone health guidelines to ensure the best possible prevention of BREs and maintain bone health and cancer prognosis in patients with ER + eBC.
摘要：
目的：在绝经后激素受体阳性乳腺癌（ER+eBC）患者中，芳香化酶抑制剂(AIs)广泛用于有效预防复发。然而,AI降低骨密度，增加骨相关事件（BRE）。除了补充钙和维生素D3，双膦酸盐和地诺单抗是改善骨骼健康和乳腺癌预后的众所周知的选择。本研究旨在评估现实世界中EReBC患者基于骨骼健康指南的管理实践模式。
方法：总共，这项回顾性队列研究包括2009年至2014年在巴塞尔大学医院接受ER+eBC治疗的68例患者。对图表评论进行了分析。基线,临床病理,治疗,并提取BRE数据。每位患者都接受了瑞士骨骼健康指南（瑞士骨质疏松协会2010[SVGO]）的治疗依从性。
结果：患者平均年龄为66.5岁（范围，56-74）年，所有绝经后。最常见的肿瘤特征是pT1-pT2的肿瘤大小（N=53，77.9％）和来曲唑治疗（N=35，51.5％），其次是他莫昔芬作为转换策略（N=27，40.3%）。AIs的中位治疗时间为47(范围，30-60）个月。五名患者（7.8％）在AI治疗期间或之后发生骨折。此外，51例（75％）患者根据SVGO建议进行治疗。
结论：我们的回顾性队列中的骨折率与较大的III期随机试验中的骨折率相当。骨骼健康指南的依从性令人满意，但仍欠佳。临床医生应严格遵守当前的骨健康指南，以确保对BRE的最佳预防，并维持ER+eBC患者的骨健康和癌症预后。
方法：总共，这项回顾性队列研究包括2009年至2014年在巴塞尔大学医院接受ER+eBC治疗的68例患者。对图表评论进行了分析。基线,临床病理,治疗,并提取BRE数据。每位患者都接受了瑞士骨骼健康指南（瑞士骨质疏松协会2010[SVGO]）的治疗依从性。
结果：患者平均年龄为66.5岁（范围，56-74）年，所有绝经后。最常见的肿瘤特征是pT1-pT2的肿瘤大小（N=53，77.9％）和来曲唑治疗（N=35，51.5％），其次是他莫昔芬作为转换策略（N=27，40.3%）。AIs的中位治疗时间为47(范围，30-60）个月。五名患者（7.8％）在AI治疗期间或之后发生骨折。此外，51例（75％）患者根据SVGO建议进行治疗。
结论：我们的回顾性队列中的骨折率与较大的III期随机试验中的骨折率相当。骨骼健康指南的依从性令人满意，但仍欠佳。临床医生应严格遵守当前的骨健康指南，以确保对BRE的最佳预防，并维持ER+eBC患者的骨健康和癌症预后。
