Focus on bone health in breast cancer endocrine therapy

  About 1/3 of our 60- to 70-year-olds suffer from osteoporosis, and the incidence of osteoporosis in people over 80 years of age accounts for more than half of the cases. The incidence of osteoporosis is 900 times higher than the consultation rate; 75% of postmenopausal women suffering from osteoporosis do not receive treatment. Breast cancer patients are often treated with chemotherapy, radiation, ovarian suppression, and aromatase inhibitors (AI), which can lead to bone loss, so special attention should be paid to bone health in breast cancer patients.  Residual estradiol concentrations during menopause are important for maintaining bone health, and AI therapy increases bone loss. A possible mechanism for the increased risk of fracture during effective AI therapy is increased bone metabolism and exacerbated bone loss due to the inhibitory effects of estradiol. It is important to monitor bone during AI treatment, as decreased bone mineral density increases the risk of fracture, so mammologists need to pay extra attention to bone health issues for proper prevention and management. Dual energy X-ray absorptiometry (DEXA) is the current gold standard for bone densitometry and can be used to control bone events during AI treatment by monitoring bone density and combining it with bisphosphonates.  In terms of osteoporosis monitoring, measurement of bone mineral density is an important method, but for hospitals without a bone densitometer, clinical manifestations should be used as a starting point. For example, being short and thin is a high risk factor for osteoporosis, and low back pain and height shortening are common clinical symptoms of osteoporosis. If the patient is over 65 years old, has a history of fracture, has lost more than 50px of height, has recently lost more than 5% of body weight, has a fracture patient in the first degree immediate family, has late menarche, early menopause, has low calcium intake, has vitamin D deficiency, smokes, has excessive alcohol intake, and has little activity in general, bone densitometry should be included in the routine examination.  The Expert Consensus on Clinical Diagnosis and Treatment of Bone Metastases and Bone Related Diseases in Malignant Tumors (2007 edition) suggests that patients with malignant tumors who have already lost bone mass (BMD -2.5 < T≤-1) should have lifestyle modification, calcium and vitamin D supplementation; patients with cancer who have already had osteoporosis (T≤-2.5) or fractures should choose lifestyle modification, calcium, vitamin D and bisphosphonates. For patients with existing osteoporosis (T≤5) or fracture, lifestyle modification, calcium, vitamin D and bisphosphonates should be chosen. Calcium 500-1000 mg/d, vitamin D 400-800 U/d, physical exercise, and smoking risk are recommended. If osteoporosis is severe, bisphosphonates may be used for treatment. In addition, calcium-rich foods can be taken: milk, rib soup, tofu, soybean paste, shrimp skin, sesame, lentils, etc.