ABSTRACT
BACKGROUND: Chemotherapy with 5-fluorouracil, epirubicin and cyclophosphamide (FEC) is now indicated for adjuvant therapy of breast cancer. Its effects on serum bone markers and bone metabolism are unclear. PATIENTS AND METHODS: The bone formation marker serum osteocalcin, the bone resorption marker serum carboxyterminal telopeptide of type I collagen (CTx), serum parathyroid hormone (PTH), 25-hydroxyvitamin D (25(OH)D) and calcium concentrations were assessed in nine premenopausal breast cancer patients with no distant metastases at baseline, before the fourth cycle and after the ninth cycle of FEC therapy. All patients became amenorrheic during chemotherapy. RESULTS: Individual values of bone markers remained within the reference ranges. The mean concentrations increased slightly. The only significant changes from baseline were observed in serum osteocalcin; concentrations were 17.6+/-4.9 microg/l (mean+/-SD), 17.5+/-4.2 microg/l, 22.8+/-6.4 microg/l (p=0.003). Serum CTx concentrations were 998+/-605 pmol/l, 886+/-562 pmol/l and 1473+/-1102 pmol/l at baseline, before the 4th and after the 9th cycle (p=ns). Serum 25(OH)D concentrations were all very low (mean concentrations were 26.6+/-10.1 mmol/l, 29.9+/-6.5 mmol/l and 27.7+/-10.6 mmol/l) and remained stable as did mean serum PTH and calcium concentrations. CONCLUSION: The finding of slight increases of the bone markers suggests early bone loss in premenopausal women. The independent effects of estrogen deprivation on bone cannot be separated from the effects of FEC therapy on bone.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone and Bones/metabolism , Breast Neoplasms/blood , Breast Neoplasms/drug therapy , Vitamin D/analogs & derivatives , Adult , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Bone Neoplasms/blood , Bone Neoplasms/metabolism , Bone Resorption/blood , Breast Neoplasms/pathology , Collagen/blood , Collagen Type I , Cyclophosphamide/administration & dosage , Epirubicin/administration & dosage , Female , Fluorouracil/administration & dosage , Humans , Middle Aged , Neoplasm Staging , Osteocalcin/blood , Parathyroid Hormone/blood , Peptides/blood , Vitamin D/bloodABSTRACT
BACKGROUND: Little is known about the effect of vitamin D status on bone gain in adolescents. OBJECTIVE: The objective was to examine whether vitamin D status is associated with accrual of bone mineral density (BMD) and bone mineral apparent density (BMAD). DESIGN: This 3-y prospective study examined the association between changes in BMD or BMAD and serum 25-hydroxyvitamin D [25(OH)D] in 171 healthy Finnish girls aged 9-15 y. Lumbar spine and femoral neck BMDs were measured by dual-energy X-ray absorptiometry. RESULTS: Baseline 25(OH)D correlated significantly with the unadjusted 3-y change in BMD at the lumbar spine (r = 0.35, P < 0.001) and femoral neck (r = 0.32, P < 0.001) in all participants. The difference from baseline in adjusted 3-y BMD accumulation between those with severe hypovitaminosis D [25(OH)D < 20 nmol/L] and those with a normal vitamin D status [25(OH)D > or = 37.5 nmol/L] was 4% (12.7%, 13.1%, and 16.7% for the lowest, middle, and highest tertiles of 25(OH)D, respectively; P for trend = 0.01) at the lumbar spine in the girls with advanced sexual maturation at baseline (n = 129). Moreover, the adjusted change in lumbar spine BMD was 27% greater in the highest vitamin D intake tertile than in the lowest tertile in the same girls (P for trend = 0.016). CONCLUSIONS: Pubertal girls with hypovitaminosis D seem to be at risk of not reaching maximum peak bone mass, particularly at the lumbar spine. Dietary enrichment or supplementation with vitamin D should be considered to ensure an adequate vitamin D status.
