尽管目前治疗相关性骨质流失受到越来越多的关注，但乳腺癌女性在不同月经状态或化疗方案下所引起的骨质流失和骨代谢指标的变化差异尚不明确。本研究的目的是探讨不同化疗方案对骨健康的影响。该自对照研究纳入了初诊的无远处转移的乳腺癌女性，她们在重庆乳腺癌中心进行了双能X线吸收密度（DXA）骨密度筛查和（或）骨代谢指标监测。我们进行了Mann-Whitney U检验、Cochran's Q检验和Wilcoxon符号秩检验。化疗后，腰1-4椎骨密度和全腰椎骨密度在统计学上显著下降（每6个月下降1.8%），导致骨质疏松症比例显著增加（27.1% vs. 20.5%，P < 0.05），主要出现在绝经前组（每6个月下降7.0%）。在经验毒素化疗（EC，表阿霉素+环磷酰胺）、七氟磷酸钠-环磷酰胺化疗（TC）、七氟磷酸钠-表阿霉素-环磷酰胺化疗（TEC）和EC-七氟磷酸钠-三氯镍胺化疗（EC-T(H)）的化疗方案中，EC方案对骨密度的不良影响最小，而EC-TH方案对骨密度的不良影响最大（有显著性差异，P < 0.05），对EC-T方案之间差异不显著，这主要出现在绝经后组。经化疗引起的闭经（雌二醇 94 pg/mL vs. 22 pg/mL；促黄体生成素 9.33 mIU/mL vs. 61.27 mIU/mL）在绝经前亚组中得到证实（P < 0.001）。除了补充钙/维生素D的绝经后人群外，化疗后经测定的白蛋白调整钙显著增加（2.21 mmol/L vs. 2.33 mmol/L，P < 0.05）。在补充钙/维生素D的绝经后人群中，β-CTX显著降低（0.56 ng/mL vs. 0.39 ng/mL，P < 0.05），同时骨密度不受化疗影响（P > 0.05）。在补充钙/维生素D的绝经前人群中，甲状旁腺激素显著降低（52.90 pg/mL vs. 28.80 pg/mL，P = 0.008），髋关节骨密度在化疗后增加（0.845 g/m2 vs. 0.952 g/m2，P = 0.006）。对于未补充钙/维生素D的绝经后和绝经前人群，化疗后髋关节和腰椎骨量显著降低（0.831 g/m2 vs. 0.776 g/m2；0.895 g/m2 vs. 0.870 g/m2，P < 0.05）。化疗可能导致中国乳腺癌患者骨质疏松和脊柱骨质丢失，不同方案有差异。补充钙/维生素D可改善骨转换标志物、骨代谢指标和骨密度。乳腺癌患者在化疗期间需要早期干预骨健康。© 2023. 作者（们）授予 Springer Verlag GmbH Germany，属于 Springer Nature 的独家许可。

Although the therapy-related bone loss attracts increasing attention nowadays, the differences in chemotherapy-induced bone loss and bone metabolism indexes change among breast cancer (BC) women with different menstrual statuses or chemotherapy regimens are unknown. The aim of the study is to explore the effects of different regimens of chemotherapy on bone health.The self-control study enrolled 118 initially diagnosed BC women without distant metastasis who underwent dual-energy X-ray absorptiometry (DXA) bone mineral density (BMD) screening and (or) bone metabolism index monitoring during chemotherapy at Chongqing Breast Cancer Center. Mann-Whitney U test, Cochran's Q test, and Wilcoxon sign rank test were performed.After chemotherapy, the BMD in the lumbar 1-4 and whole lumbar statistically decreased (- 1.8%/per 6 months), leading to a significantly increased proportion of osteoporosis (27.1% vs. 20.5%, P < 0.05), which were mainly seen in the premenopausal group (- 7.0%/per 6 months). Of the chemotherapeutic regimens of EC (epirubicin + cyclophosphamide), TC (docetaxel + cyclophosphamide), TEC (docetaxel + epirubicin + cyclophosphamide), and EC-T(H) [epirubicin + cyclophosphamide-docetaxel and/or trastuzumab], EC regimen had the least adverse impact on BMD, while the EC-TH regimen reduced BMD most (P < 0.05) inspite of the non-statistical difference between EC-T regimen, which was mainly seen in the postmenopausal group. Chemotherapy-induced amenorrhea (estradiol 94 pg/ml vs, 22 pg/ml; FSH 9.33 mIU/ml vs. 61.27 mIU/ml) was proved in premenopausal subgroup (P < 0.001). Except the postmenopausal population with calcium/VitD supplement, the albumin-adjusted calcium increased significantly (2.21 mmol/l vs. 2.33 mmol/l, P < 0.05) after chemotherapy. In postmenopausal group with calcium/VitD supplement, β-CTX decreased significantly (0.56 ng/ml vs. 0.39 ng/ml, P < 0.05) and BMD were not affected by chemotherapy (P > 0. 05). In premenopausal group with calcium/VitD supplement, PTH decreased significantly (52.90 pg/ml vs. 28.80 pg/ml, P = 0. 008) and hip BMD increased after chemotherapy (0.845 g/m2 vs. 0.952 g/m2, P = 0. 006). As for both postmenopausal and premenopausal group without calcium/VitD supplement, there was a significant decrease in bone mass in hip and lumbar vertebrae after chemotherapy (0.831 g/m2 vs. 0.776 g/m2; 0.895 g/m2 vs. 0.870 g/m2, P < 0.05).Chemotherapy might induce lumbar vertebrae BMD loss and spine osteoporosis with regimen differences among Chinese BC patients. Calcium/VitD supplementation could improve bone turnover markers, bone metabolism indicators, and bone mineral density. Early interventions on bone health are needed for BC patients during chemotherapy.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.