Effects of oral clodronate on bone mineral density in patients with relapsing breast cancer

被引:27
|
作者
Rizzoli, R
Forni, M
Schaad, MA
Slosman, DO
Sappino, AP
Garcia, J
Bonjour, JP
机构
[1] UNIV HOSP GENEVA,DEPT MED,DIV ONCOL,CH-1211 GENEVA 14,SWITZERLAND
[2] UNIV HOSP GENEVA,DEPT RADIOL,DIV NUCL MED,CH-1211 GENEVA 14,SWITZERLAND
[3] UNIV HOSP GENEVA,DEPT RADIOL,DIV RADIODIAGNOSIS,CH-1211 GENEVA 14,SWITZERLAND
关键词
bone metastasis; osteoporosis; clodronate; bisphosphonates; bone mineral density; breast cancer;
D O I
10.1016/8756-3282(96)00075-0
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The high prevalence of bone metastases in breast cancer and the risk that spinal and femoral osteoporosis may add further morbidity provide a rationale for bisphosphonate therapy in patients with skeletal metastases from mammary carcinoma, We investigated the effects of oral clodronate given during 9 months, with a 24-month follow-up, on bone mineral density (BMD), on biochemical markers of bone remodeling, and on osseous complications in 67 women with documented relapsing breast cancer, aged 58.7 +/- 1.5 years (x +/- SEM). Patients with active cancer disease were randomly allocated to two groups, with or without clodronate treatment (1600 mg/day, orally). Twenty-six women considered in complete remission (52.4 +/- 2.4 years) were also studied. Expressed in deviation from gender- and age-matched normals (z score), base-line BMD at the levels of lumbar spine (LS), femoral neck (FN), and midfemoral shaft (FS) was +0.10 +/- 0.22 vs, -0.12 +/- 0.25, +0.03 +/- 0.19 vs, -0.54 +/- 0.24, and +0.08 +/- 0.14 vs, -0.02 +/- 0.22, in patients with active breast cancer and in subjects in remission, respectively, After 9 months of treatment, fasting urinary calcium to creatinine ratio was lower (0.26 +/- 0.04 vs, 0.40 +/- 0.04 mmol/mmol creatinine, p < 0.02) and serum osteocalcin was stabilized (-2.1 +/- 1.1 vs. +7.0 +/- 3.3 mu g/L, as compared with pretreatment values, p < 0.02), in the clodronate-treated group. The rate of osseous complications (pathological fracture, hypercalcemic episode, scintigraphic or radiological evidence of metastasis development, chemo- or radiotherapy for bone disease progression) was 28.8 events per 100 patient-year in the clodronate-treated group vs. 39.0 in controls, and 31.5 vs, 40.5, after 9 and 15 months of follow-up, respectively. In 15 women without evident LS bone metastasis (7 clodronate-treated and 8 controls). LS BMD increased in the clodronate-treated group by +5.2 +/- 2.5% vs, -0.3 +/- 1.4%, and +8.1 +/- 4.7 vs, -0.9 +/- 1.7, after 10.3 +/- 0.4 and 17.3 +/- 1.2 months, respectively (p < 0.01), as compared with pretreatment values, These results indicate that clodronate treatment decreased bone turnover and attenuated cancer-related bone morbidity, In addition, clodronate increased LS BMD in apparently unaffected bone of women with relapsing breast cancer.
引用
收藏
页码:531 / 537
页数:7
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