臨床婦人科産科70巻11号

2016年11月発行

今月の臨床 骨粗鬆症の最新トピックス─ガイドラインの大幅改訂を迎えて

原因ごとの病態

婦人科がん治療による骨粗鬆症

著者： 佐々木浩¹

所属機関： ¹大阪医科大学産婦人科

ページ範囲：P.1012 - P.1017

文献概要

●婦人科がん治療による外科的閉経は，骨密度の低下および骨折のリスクファクターである．

●化学療法における骨密度の低下は，化学療法による卵巣機能障害が関連している．

●高齢子宮頸がん患者に放射線治療を行う場合は，骨盤不全骨折の発症に注意が必要である．

●乳がん治療の術後補助療法としてアロマターゼ阻害薬を用いる場合は，定期的な骨密度測定を行うべきである．

参考文献

1）Yoshida T, et al : Impact of surgical menopause on lipid and bone metabolism. Climacteric 14 : 445─452, 2011

2）Pouilles JM, et al : The effects of menopause on longitudinal bone loss from the spine. Calcif Tissue Int 52 : 340─343, 1993

3）Ahlborg HG, et al : Bone loss in relation to menopause : a prospective study during 16 years. Bone 28 : 327─331, 2001

4）Melton LJ 3rd, et al : Fracture risk after bilateral oophorectomy in elderly women. J Bone Miner Res 18 : 900─905, 2003

5）日本婦人科腫瘍学 : 会卵巣がん治療ガイドライン2015年版．金原出版，2010

6）Nicosia SV, et al : Gonadal effects of cancer therapy in girls. Cancer 55 : 2364─2372, 1985

7）Wallace WH, et al : Gonadal dysfunction due to cis-platinum. Med Pediatr Oncol 7 : 409─413, 1989

8）Shapiro CL, et al : Ovarian failure after adjuvant chemotherapy is associated with rapid bone loss in women with early-stage breast cancer. J Clin Oncol 19 : 3306─3311, 2001

9）Huh SJ, et al : Pelvic insufficiency fracture after pelvic irradiation in uterine cervix cancer. Gynecol Oncol 86 : 264─268, 2002

10）Tokumaru S, et al : Pelvic insufficiency fracture after pelvic irradiation in uterine cervix cancer. J Radiat Res 54 : 1102─1109, 2013

11）Oh D, et al : Pelvic insufficiency fracture after pelvic radiotherapy for cervical cancer : analysis of risk factors. Int J Radiat Oncol Biol Phys 70 : 1183─1188, 2008

12）Wei RL, et al : Bone mineral density loss in thoracic and lumbar vertebrae following radiation for abdominal cancers. Radiother Oncol 118 : 430─436, 2016

13）Hadji P : Aromatase inhibitor-associated bone loss in breast cancer patients is distinct from postmenopausal osteoporosis. Crit Rev Oncol Hematol 69 : 73─82, 2009

14）Delmas PD, et al : Bisphosphonate risedronate prevents bone loss in women with artificial menopause due to chemotherapy of breast cancer : a double-blind, placebo-controlled study. J Clin Oncol 15 : 955─962, 1997

15）Gnant M, et al : Adjuvant endocrine therapy plus zoledronic acid in premenopausal women with early-stage breast cancer : 5-year follow-up of the ABCSG-12 bone-mineral density substudy. Lancet Oncol 9 : 840─849, 2008

16）Brufsky A, et al : Zoledronic acid inhibits adjuvant letrozole-induced bone loss in postmenopausal women with early breast cancer. J Clin Oncol 25 : 829─836, 2007

17）Dören M, et al : Effects of specific post-menopausal hormone therapies on bone mineral density in post-menopausal women : a meta-analysis. Hum Reprod 18 : 1737─1746, 2003

18）Bone HG, et al : Alendronate and estrogen effects in postmenopausal women with low bone mineral density. Alendronate/Estrogen Study Group. J Clin Endocrinol Metab 85 : 720─726, 2000

19）Singh P, et al : Hormone replacement after gynaecological cancer. Maturitas 65 : 190─197, 2010

20）Ploch E : Hormonal replacement therapy in patients after cervical cancer treatment. Gynecol Oncol 26 : 169─177, 1987

21）Lee RB, et al : Estrogen replacement therapy following treatment for stage I endometrial carcinoma. Gynecol Oncol 36 : 189─191, 1990

22）Chapman JA, et al : Estrogen replacement in surgical stage I and II endometrial cancer survivors. Am J Obstet Gynecol 75 : 1195─1200, 1996

23）Ayhan A, et al : Does immediate hormone replacement therapy affect the oncologic outcome in endometrial cancer survivors? Int J Gynecol Cancer 16 : 805─808, 2006

24）Barakat RR, et al : Randomized double-blind trial of estrogen replacement therapy versus placebo in stage I or II endometrial cancer : a Gynecologic Oncology Group Study. J Clin Oncol 24 : 587─592, 2006

25）Eeles RA, et al : Hormone replacement therapy and survival after surgery for ovarian cancer. BMJ 302 : 259─262, 1991

26）Guidozzi F, et al : Estrogen replacement therapy for ovarian carcinoma survivors : A randomized controlled trial. Cancer 86 : 1013─1018, 1999

27）Ursic-Vrscaj M, et al : Hormone replacement therapy after invasive ovarian serous cystadenocarcinoma treatment : the effect on survival. Menopause 8 : 70─75, 2001

28）Mascarenhas C, et al : Use of hormone replacement therapy before and after ovarian cancer diagnosis and ovarian cancer survival. Int J Cancer 119 : 2907─2915, 2006

29）Col NF, et al : Menopausal hormone therapy after breast cancer : a meta-analysis and critical appraisal of the evidence. Breast Cancer Res 7 : R535─540, 2005

30）Holmberg L, et al : Increased risk of recurrence after hormone replacement therapy in breast cancer survivors. J Natl Cancer Inst 100 : 475─482, 2008

31）Barrett-Connor E, et al : Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women. N Engl J Med 355 : 125─137, 2006

32）Vadlamudi RK, et al : Deregulation of estrogen receptor coactivator proline-, glutamic acid-, and leucine-rich protein-1/modulator of nongenomic activity of estrogen receptor in human endometrial tumors. J Clin Endocrinol Metab 89 : 6130─6138, 2004

33）Sasaki H, et al : Difference between genomic actions of estrogen versus raloxifene in human ovarian cancer cell lines. Oncogene 27 : 2737─2745, 2008

34）Ellis GK, et al : Randomized trial of denosumab in patients receiving adjuvant aromatase inhibitors for nonmetastatic breast cancer. J Clin Oncol 26 : 4875─4882, 2008

35）Gnant M, et al : Adjuvant denosumab in breast cancer（ABCSG-18） : a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 386 : 433─443, 2015

36）Gralow JR, et al : NCCN Task Force Report : Bone Health In Cancer Care. J Natl Compr Canc Netw 3 : S1─50, 2013