Automated CT-based analysis to detect changes in the prevalence of lytic bone metastases from breast cancer

The spinal column is the most frequent site of bone metastasis in patients with breast cancer. It is important to understand how the pattern of vertebral lesions may be affected by the introduction of modern cancer therapies. The purpose of this study was to characterize changes in the radiological appearance of spinal column metastases over the past decade using highly automated Computed Tomography (CT) based computational analysis methods. Two case series studies were performed using CT scans of patients with confirmed spinal metastases secondary to breast cancer: Cohort A with CT scans acquired between 1998 and 2001 and Cohort B with CT scans acquired between 2004 and 2007. Diseased vertebrae were classified as lytic, blastic, or mixed based on CT scan intensity through an automated 3D computer algorithm. The relative incidence of lytic vertebral metastases decreased in comparing Cohort B to Cohort A (12% vs. 49%) with a corresponding increase in mixed lesions (51% vs. 18%) Significant associations were found between the percentage of lytic lesions in number of diseased vertebrae measured per patient and lack of bisphosphonate use (RR = 2.6) and for membership in Cohort A vs. Cohort B (RR = 5.9). This work highlights a change in the CT appearance of vertebral metastases from breast cancer during the past decade toward a lower proportion of lytic disease. Observation of patient therapies suggests that differences in radiological assessment may be linked, at least in part, to bisphosphonate use. These findings have important implications for both clinical practice and research strategies involving vertebral metastases.     

我院2007-2009年抗骨质疏松症药应用分析

目的:了解我院抗骨质疏松症药的应用现状及趋势。方法:根据我院药品计算机管理系统提取的数据资料,从不同角度进行统计、分析。结果:我院2007-2009年抗骨质疏松症药销售金额逐年上升,双膦酸盐类药所占比例较大,达50%以上;中药类所占比例逐年上升,2009年升至第2位;性激素类药所占比例较小,每年均低于4%。国产药占主导地位,每年均占80%以上。结论:双膦酸盐类药已成为我院临床医师治疗骨质疏松症的首选药物。     

Osteonecrosis of the jaw and bisphosphonate treatment for osteoporosis

A potential side effect associated with bisphosphonates, a class of drugs used in the treatment of osteoporosis, Paget's disease and metastatic bone disease, is osteonecrosis of the jaw (ONJ). The incidence of ONJ in the general population is unknown; this rare condition also may occur in patients not receiving bisphosphonates. Case reports have discussed ONJ development in patients with multiple myeloma or metastatic breast cancer receiving bisphosphonates as palliation for bone metastases. These patients are also receiving chemotherapeutic agents that might impair the immune system and affect angiogenesis. The incidence or prevalence of ONJ in patients taking bisphosphonates for osteoporosis seems to be very rare. No causative relationship has been unequivocally demonstrated between ONJ and bisphosphonate therapy. A majority of ONJ occurs after tooth extraction. Furthermore, the underlying risk of developing ONJ may be increased in osteoporotic patients by comorbid diseases. Treatment for ONJ is generally conservative.     

The effect of zoledronic acid on bone mineral density in patients undergoing androgen deprivation therapy

Purpose

The aim of this study was to evaluate the efficacy and safety of zoledronic acid compared with placebo in preventing bone mineral density (BMD) loss and suppressing bone markers when initiated during the first year of androgen deprivation therapy in patients with locally advanced prostate cancer.

Patients and Methods

Patients were randomized to receive zoledronic acid 4 mg or placebo intravenously every 3 months. Lumbar spine (LS) and total hip BMD was measured using dual-energy x-ray absorptiometry at baseline and at week 52. N-telopeptide (NTX) and bone-specific alkaline phosphatase (BSAP) were evaluated at baseline and every 12 weeks. Safety assessments were performed throughout the study.

Results

Efficacy analyses included 106 patients and 109 patients in the zoledronic acid and placebo groups, respectively. At week 52, the least squares mean BMD percentage differences were 6.7% for LS and 3.7% for total hip (P < 0.0001 for both). In the zoledronic acid group, decreases in NTX (−14% to −28%) and BSAP (−31% to −37%) levels were significant and sustained; changes in NTX levels and LS BMD (r = −0.25; P = 0.04) and in BSAP levels and hip BMD (r = −0.28; P = 0.02) were significantly correlated. Only traumatic fractures were reported for 2 and 3 patients receiving zoledronic acid and placebo, respectively. One patient in each group experienced acute renal failure. Osteonecrosis of the jaw was not reported.

Conclusion

Zoledronic acid (4 mg intravenously every 3 months) was safe and effective in preventing bone loss and reducing bone turnover in patients with prostate cancer when initiated during the first year of androgen deprivation therapy; patients with low baseline BMD experienced the greatest benefit.     

羟考酮控释片联合双膦酸盐治疗骨转移癌69例

背景：盐酸羟考酮控释片属于第3阶梯用药，是治疗中重度癌痛的主要方法之一。 目的：观察盐酸羟考酮控释片联合双膦酸盐治疗骨转移癌性疼痛的疗效及不良反应。 方法：对69例骨转移癌患者口服盐酸羟考酮控释片治疗，在用药过程中根据疼痛缓解程度调整剂量；同时静脉滴注唑来膦酸4 mg每4周1次，连续2次后评价疗效和不良反应。 结果与结论：发现骨转移癌患者的骨痛完全缓解25例(36%)，部分缓解37例(54%)，轻度缓解7例(10%)，总有效率为90% (62/69)；不良反应有便秘、恶心呕吐、腹胀、厌食、嗜睡、头晕、发热、肌肉痛等。结果表明，盐酸羟考酮控释片联合双膦酸盐治疗骨转移癌性疼痛疗效确切，有效率高，不良反应轻，患者可以耐受。 关键词：盐酸羟考酮控释片；双膦酸盐；骨转移癌；疼痛；药物控释系统及其载体材料 doi:10.3969/j.issn.1673-8225.2010.25.028     

Epidemiology,treatment and costs of osteoporosis in Germany—the BoneEVA Study

INTRODUCTION: In Germany, accurate data on the prevalence and treatment of osteoporosis, as well as the cost of this illness, are not available. The aim of this study is to give a valid estimation of these items for the year 2003. METHODS: Routine data from a German sickness fund covering 1.5 million beneficiaries and billing data for outpatient visits were used to obtain estimates of prevalence for osteoporosis. Claims data for patients with osteoporosis (M80, M81) or an osteoporosis-related fracture diagnosis (S22, S32, S42, S52, S72, S82) or treatment with anti-osteoporosis drugs were examined. Costs were calculated from the perspective of the German health insurance system and the German nursing care insurance system, respectively. Only direct costs of osteoporosis were considered. RESULTS: In 2003, 7.8 million Germans (6.5 million women) were affected by osteoporosis. Of them, 4.3% experienced at least one clinical fracture. Only 21.7% were treated with an anti-osteoporosis drug. The total direct costs attributable to osteoporosis amounted to euros 5.4 billion. CONCLUSION: This study confirms that osteoporosis is underdiagnosed, undertreated and imposes a considerable economic burden on the health system in Germany. Effective strategies for the prevention and management of this disease are needed.