Fracture Risk And The Adjuvant Endocrine Therapy In Postmenopausal Women With Estrogen Receptor-positive Early Breast Cancer:A Nretwork Meta-analysis

Object Adjuvant endocrine therapy(aromatase inhibitor,tamoxifen and tamoxifen switch to AI)play an important role in treatment of postmenopausal women with early breast cancer.However,the long term adjuvant endocrine therapy will increase the bone fracture risk.To date,there was no head-to-head trial to compare the bone fracture risk of all endocrine therapy option.Therefore,we perform a network meta-analysis to obtain the optimal therapy option in terms of bone fracture.Methods We search PubMed,MEDLINE,Chinese biomedical literature database,Wangfang database,for randomized controlled trials(RCTs)according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines before November 27,2016.The primarily outcomes was any grades of bone fracture.The traditional meta-analysis was carried out using STATA 12.0 software and network meta-analysis was conducted by means of gemtc,rjags in R software,version 3.2.0.Results The search identified 14 studies involving 4 different treatment regimens.The results of traditional meta-analysis showed that the risk was similar between the aromatase inhibitors(AIs)alone and tamoxifen(OR=1.53,95%CI 0.85-1.57).When compared with placebo,AIs were associated with the increased bone fracture risk(OR=1.31,95%CI 1.09-1.56).The result of network meta-analysis suggested that the AIs were associated with the increased fracture risk when compared with tamoxifen or placebo(OR=1.43,95%CrI 1.16-1.75;OR=1.33,95%CrI 1.06-1.69).However,no significant difference was measured between the AI alone and sequential therapy(OR=1.16,95%CrI 0.95-1.43).Conclusion The results suggest that sequential therapy should be the optimal option for those postmenopausal women with early breast cancer and at high risk of bone fractures.