| Background and purpose:The incidence of breast cancer ranks the first among female malignant tumors,and chemotherapy is an important part of its comprehensive treatment.Osteoporosis associated with chemotherapy for breast cancer is one of the side effects of chemotherapy.In this study,bone mineral density of breast cancer patients before and after chemotherapy and during systematic follow-up period was analyzed to evaluate the effect of chemotherapy on bone mineral density of breast cancer.Methods : Breast cancer patients who received dual-energy X-ray bone densitometry at Department of Endocrine and Breast Surgery,the First Affiliated Hospital of Chongqing Medical University from January2015 to February 2020 were enrolled to evaluate and compare changes in bone mineral density of breast cancer patients before and after chemotherapy and during follow-up period.Results:1.A total of 245 breast cancer patients were initial diagnosed in thestudy,286 patients were treated with chemotherapy,and 414 patients were systematically followed up.A high proportion of abnormal bone mass was found in the three groups(73.5%,73.8%,82.9%),among which the proportion of osteoporosis was 27.8%,26.2%,and 35.0%,respectively.2.After removing patients without chemotherapy in the initial-diagnosed and follow-up group(total 112 cases),the actual population included in the initial-diagnosed group,chemotherapy group and follow-up group were 182 cases,286 cases,and 365 cases,respectively.The percentage of abnormal lumbar bone mass in the follow-up group is79.4%,which was higher than the initial-diagnosed group(63.4%)and the chemotherapy group(68.1%)patients,and the differences were statistically significant(P < 0.05).The proportions of abnormal hip bone mass in the three groups were 56.7%,52% and 47.6%,respectively,and the difference was not statistically significant.3.Lumbar bone density results showed that the lumbar bone density in the chemotherapy group of breast cancer patients slightly decreased compared with the initial diagnosed group,and the difference was not statistically significant.Bone mineral density of the lumbar spine(T value of L1-L4 and the whole lumbar spine,Z value of L2)decreased in the follow-up group compared with the chemotherapy group(P < 0.05).Bone mineral density of the follow-up group was lower than that of the initial diagnosis group(T value and Z value of L1-L3 and the whole lumbarspine,T value of L4)(P < 0.05).4.The results of hip bone mineral density showed that the bone mineral density of the hip(Z value of the femoral trochanter)in the chemotherapy group of breast cancer was lower than that in the initial diagnosis group(P < 0.05),but the Z value of the femoral trochanter was higher in the follow-up group than that in the chemotherapy group(P <0.05).At the same time,the Ward's T value of the hip in the follow-up group decreased compared with that in the initial diagnosis group(P <0.05).5.Age stratification of further bone classification showed that among breast cancer patients aged 45-54 years old,the proportion of abnormal lumbar bone mass in the chemotherapy group(67.6%)was higher than that in the initial diagnosis group(58.2%),but the difference was not statistically significant.The proportion of abnormal lumbar bone mass in the follow-up group(78.1%)was significantly higher than that in the initial diagnosis group(58.2%),and the difference was statistically significant(P< 0.05).However,in the age stratification of ?44 years and ?55 years,there was no statistical difference in the proportion of abnormal lumbar bone mass in the three groups.At the same time,the proportion of abnormal hip bone mass in the three groups was not statistically different in all age groups.6.Further age stratification of lumbar spine density showed that inbreast cancer patients aged 44 years old and younger,lumbar bone mass(T value of L2)was lower in the follow-up group than in the initial diagnosis group(P < 0.05).In the age group of 45-54 years old,bone mineral density of the follow-up group was lower than that of the initial diagnosis group(T value and Z value of L1-L4 and the whole lumbar spine)(P < 0.05).The bone mineral density of the lumbar spine(T values and Z values of L1?,L2 and the whole lumbar spine)decreased during follow-up compared with that of the chemotherapy group(P < 0.05).There was no significant difference in lumbar bone mass among the three groups in age group ?55years old.7.Further age stratification of hip density showed no statistically significant difference in hip bone mass between the three groups among breast cancer patients aged 44 years old and younger.However,in the age group of 45-54 years old,hip bone mass(T value and Z value of femoral trochanter)was lower than that of the initial diagnosis after chemotherapy(P < 0.05).The bone mineral density of the hip in the follow-up group was lower than that in the initial group(ward's T)(P < 0.05).However,in the age stratification over 55 years old,bone mineral density increased in the follow-up group compared with the chemotherapy group(P<0.05).8.The self-comparison results of bone classification showed that 55 patients had bone mineral density detected before and after chemotherapy,82 patients had bone mineral density detected after chemotherapy andduring follow-up,and 44 patients had bone mineral density detected during initial diagnosis and follow-up.After chemotherapy,the proportion of abnormal bone mass in the hip and lumbar spine was 59.3% and 64.6%,respectively.Compared with the initial diagnosed population(59.3%,60.4%),the difference was not statistically significant.However,compared with the chemotherapy group,the abnormal proportion of hip bone mass in the follow-up group was reduced to 59.7% and 51.9%,respectively(P <0.05),while the abnormal proportion of lumbar bone mass increased to65.7% and 78.6%,respectively(P < 0.05).9.The results of the lumbar spine bone density self-comparison showed that the bone mineral density of the chemotherapy group was lower than that of the initial diagnosis group(T value and Z value of L1?L2 and the whole lumbar spine)(P < 0.05).In the follow-up group,bone mineral density of the lumbar spine(T value and Z value of L1?L2?the whole lumbar spine,and T value of L3)was lower than that of the initial diagnosis(P < 0.05).In the follow-up group,bone mineral density of the lumbar spine(T value and Z value of L1,L2,L3?the whole lumbar spine)was lower than that of the chemotherapy group(P < 0.05).10.The results of hip bone mineral density self-control showed that the bone mineral density of the hip(T value and Z value of the femoral trochanter and the whole hip)in the follow-up group was higher than that in the initial confirmed group(P < 0.05).Bone mineral density in thefollow-up group was higher than that in the chemotherapy group(Z value of femoral neck,T value and Z value of the trochanter and the whole hip)(P < 0.05).There was no significant difference in hip bone mineral density between the chemotherapy group and the first diagnosis group.Conclusion1.A high proportion of abnormal bone mass and osteoporosis occurred in breast cancer patients at the initial diagnosis stage,chemotherapy stage and systematic follow-up stage.2.After chemotherapy and systematic follow-up of breast cancer,the bone mineral density of the lumbar spine and hips was significantly lower than that in the initial diagnosis stage,and the changes were most obvious in patients of 45 and 54 years old.3.Chemotherapy may cause bone mineral density decline in breast cancer patients,and bone mineral density may further decrease during follow-up,especially in patients during perimenopausal period.Thus early monitoring,intervention and regular follow-up should be carried out to reduce the occurrence of adverse bone health-related events and improve the long-term quality of life of breast cancer patients. |
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