Abstract：
The raising number of older patients who are diagnosed with breast cancer represents a significant medical and societal challenge. Aromatase inhibitors (AI), which are commonly utilized to treat this condition in these patients have significant adverse events on bone and muscle health. Falling estrogen production leads to an increase in RANKL secretion by osteoblasts with accelerated bone remodeling due to osteoclast activity. Furthermore, estrogen deficiency reduces skeletal muscle strength and mass. The humanized monoclonal antibody, denosumab, neutralizes RANKL, thereby inhibiting osteoclast formation, function and survival and ultimately exerting powerful anti-resorptive effects.. In this study, we report on the efficacy of denosumab in mitigating aromatase inhibitor-induced bone loss (AIBL) and sarcopenia in older women with breast cancer. From January 2022 to January 2023, we enrolled 30 patients (female sex, ≥ 65 years) diagnosed with non-metastatic breast cancer undergoing adjuvant endocrine therapy; patients received, as per clinical practice, primary bone prophylaxis with denosumab (60 mg via subcutaneous injection every 6 months) according to oncologic guidelines. This group was matched with 30 patients with non-metastatic breast cancer, who were treated with biphosphonates (BF) therapy (oral alendronate 70 mg/week). For each patient bone mineral density (BMD) and bone quality in terms of trabecular bone score (TBS) in addition to body composition and Relative Skeletal Muscle Index (RSMI) was assessed by bone densitometry at baseline and after one year of treatment. Significant improvements in TBS at the lumbar spine, RSMI and whole-body composition (arms, legs, and trunk) were observed in the denosumab group compared with the BF group. These findings underscore the role of denosumab as an effective strategy in managing AIBL and osteosarcopenia in older women with breast cancer and undergoing adjuvant endocrine therapy, which is crucial for improving quality of life, preventing functional decline, and optimizing treatment outcomes.
摘要：
被诊断患有乳腺癌的老年患者数量的增加代表了重大的医学和社会挑战。芳香化酶抑制剂（AI），通常用于治疗这些患者的这种情况对骨骼和肌肉健康有显著的不良事件。雌激素产生的下降导致成骨细胞的RANKL分泌增加，并由于破骨细胞活性而加速骨重建。此外，雌激素缺乏会降低骨骼肌的力量和质量。人源化单克隆抗体，denosumab,中和RANKL，从而抑制破骨细胞的形成，功能和生存，并最终发挥强大的抗吸收作用。.在这项研究中,我们报道了denosumab减轻芳香化酶抑制剂引起的老年乳腺癌患者骨丢失(AIBL)和肌肉减少症的疗效.从2022年1月到2023年1月，我们招募了30名患者(女性，≥65岁）诊断为非转移性乳腺癌，接受辅助内分泌治疗；患者接受，根据临床实践，根据肿瘤学指南，使用denosumab（每6个月皮下注射60mg）进行主要骨预防。该组与30例非转移性乳腺癌患者相匹配，他们接受了双膦酸盐（BF）治疗（口服阿仑膦酸盐70mg/周）。对于每个患者,在基线和治疗一年后,通过骨密度测定法评估骨矿物质密度(BMD)和骨质量(除了身体组成和相对骨骼肌指数(RSMI)之外,以小梁骨评分(TBS))。腰椎TBS的显着改善，RSMI和全身成分(手臂，腿,与BF组相比，denosumab组观察到树干）。这些发现强调了denosumab作为一种有效的策略在治疗老年乳腺癌患者和接受辅助内分泌治疗的AIBL和骨量减少中的作用。这对提高生活质量至关重要，防止功能下降，优化治疗结果。
