Elevated incidence of fractures in women with invasive breast cancer

B. J. Edwards*, William J Gradishar, Maureen E Smith, J. A. Pacheco, J. Holbrook, June M McKoy, Beatrice Nardone, S. Tica, V. Godinez-Puig, Alfred W Rademaker, I. B. Helenowski, Andrew D Bunta, Paula H Stern, S. T. Rosen, Dennis P West, T. A. Guise

*Corresponding author for this work

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Summary: This study evaluates the incidence of bone fractures in women with BC.We found that women with invasive breast cancer are at an increased risk for bone fractures, with fractures most commonly occurring at lower extremity and vertebral sites. The risk is further increased in women undergoing cancer therapy. Introduction: Bone loss and fractures in breast cancer have generally been attributed to aromatase inhibitor use. This study assessed the incidence of fractures after invasive breast cancer diagnosis and evaluated bone density and FRAX risk calculation at time of fracture occurrence. Methods: Retrospective cohort study of women with invasive breast cancer [June 2003–December 2011] who participated in an academic hospital based genetic biobank. Demographic and clinical characteristics were abstracted from the electronic medical record (EMR). Results: A total of 422 women with invasive breast cancer were assessed; 79 (28 %) sustained fractures during the observation period; fractures occurred at multiple skeletal sites in 27 cases (116 fractures). The incidence of fractures was 40 per 1000 person-years. Women who sustained fractures were mostly white and had a family history of osteoporosis (36.9 %, p = 0.03) or history of a prior fracture (6/79, p = 0.004). Fractures occurred 4.0 years (range 0–12 years) after cancer diagnosis. Fracture cases had femoral neck bone mineral density (BMD) of 0.72 + 0.12 g/cm2, T-score of −1.2, that is, within the low bone mass range. Fractures most commonly occurred in lower extremities, vertebral, and wrist sites. Hip fractures accounted for 11 % of fractures, occurring at a median age of 61 years. Conclusions: Fractures occur shortly after commencing cancer therapy. Rapid bone loss associated with cancer therapy may precipitate fractures. Fractures occur at relatively higher BMD in BC. Occurrence of fractures in invasive breast cancer raises the possibility of cancer-induced impairment in bone quality.

Original languageEnglish (US)
Pages (from-to)499-507
Number of pages9
JournalOsteoporosis International
Volume27
Issue number2
DOIs
StatePublished - Feb 1 2016

Fingerprint

Breast Neoplasms
Bone Fractures
Incidence
Bone Density
Cohort Studies
Bone and Bones
Lower Extremity
Neoplasms
Aromatase Inhibitors
Second Primary Neoplasms
Electronic Health Records
Femur Neck
Hip Fractures
Wrist
Osteoporosis
Retrospective Studies
Observation
Demography
Therapeutics

Keywords

  • Breast cancer
  • Disability
  • Fractures
  • Functional status
  • Morbidity
  • Women’s health

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

Edwards, B. J. ; Gradishar, William J ; Smith, Maureen E ; Pacheco, J. A. ; Holbrook, J. ; McKoy, June M ; Nardone, Beatrice ; Tica, S. ; Godinez-Puig, V. ; Rademaker, Alfred W ; Helenowski, I. B. ; Bunta, Andrew D ; Stern, Paula H ; Rosen, S. T. ; West, Dennis P ; Guise, T. A. / Elevated incidence of fractures in women with invasive breast cancer. In: Osteoporosis International. 2016 ; Vol. 27, No. 2. pp. 499-507.
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abstract = "Summary: This study evaluates the incidence of bone fractures in women with BC.We found that women with invasive breast cancer are at an increased risk for bone fractures, with fractures most commonly occurring at lower extremity and vertebral sites. The risk is further increased in women undergoing cancer therapy. Introduction: Bone loss and fractures in breast cancer have generally been attributed to aromatase inhibitor use. This study assessed the incidence of fractures after invasive breast cancer diagnosis and evaluated bone density and FRAX risk calculation at time of fracture occurrence. Methods: Retrospective cohort study of women with invasive breast cancer [June 2003–December 2011] who participated in an academic hospital based genetic biobank. Demographic and clinical characteristics were abstracted from the electronic medical record (EMR). Results: A total of 422 women with invasive breast cancer were assessed; 79 (28 {\%}) sustained fractures during the observation period; fractures occurred at multiple skeletal sites in 27 cases (116 fractures). The incidence of fractures was 40 per 1000 person-years. Women who sustained fractures were mostly white and had a family history of osteoporosis (36.9 {\%}, p = 0.03) or history of a prior fracture (6/79, p = 0.004). Fractures occurred 4.0 years (range 0–12 years) after cancer diagnosis. Fracture cases had femoral neck bone mineral density (BMD) of 0.72 + 0.12 g/cm2, T-score of −1.2, that is, within the low bone mass range. Fractures most commonly occurred in lower extremities, vertebral, and wrist sites. Hip fractures accounted for 11 {\%} of fractures, occurring at a median age of 61 years. Conclusions: Fractures occur shortly after commencing cancer therapy. Rapid bone loss associated with cancer therapy may precipitate fractures. Fractures occur at relatively higher BMD in BC. Occurrence of fractures in invasive breast cancer raises the possibility of cancer-induced impairment in bone quality.",
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Elevated incidence of fractures in women with invasive breast cancer. / Edwards, B. J.; Gradishar, William J; Smith, Maureen E; Pacheco, J. A.; Holbrook, J.; McKoy, June M; Nardone, Beatrice; Tica, S.; Godinez-Puig, V.; Rademaker, Alfred W; Helenowski, I. B.; Bunta, Andrew D; Stern, Paula H; Rosen, S. T.; West, Dennis P; Guise, T. A.

In: Osteoporosis International, Vol. 27, No. 2, 01.02.2016, p. 499-507.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Elevated incidence of fractures in women with invasive breast cancer

AU - Edwards, B. J.

AU - Gradishar, William J

AU - Smith, Maureen E

AU - Pacheco, J. A.

AU - Holbrook, J.

AU - McKoy, June M

AU - Nardone, Beatrice

AU - Tica, S.

AU - Godinez-Puig, V.

AU - Rademaker, Alfred W

AU - Helenowski, I. B.

AU - Bunta, Andrew D

AU - Stern, Paula H

AU - Rosen, S. T.

AU - West, Dennis P

AU - Guise, T. A.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Summary: This study evaluates the incidence of bone fractures in women with BC.We found that women with invasive breast cancer are at an increased risk for bone fractures, with fractures most commonly occurring at lower extremity and vertebral sites. The risk is further increased in women undergoing cancer therapy. Introduction: Bone loss and fractures in breast cancer have generally been attributed to aromatase inhibitor use. This study assessed the incidence of fractures after invasive breast cancer diagnosis and evaluated bone density and FRAX risk calculation at time of fracture occurrence. Methods: Retrospective cohort study of women with invasive breast cancer [June 2003–December 2011] who participated in an academic hospital based genetic biobank. Demographic and clinical characteristics were abstracted from the electronic medical record (EMR). Results: A total of 422 women with invasive breast cancer were assessed; 79 (28 %) sustained fractures during the observation period; fractures occurred at multiple skeletal sites in 27 cases (116 fractures). The incidence of fractures was 40 per 1000 person-years. Women who sustained fractures were mostly white and had a family history of osteoporosis (36.9 %, p = 0.03) or history of a prior fracture (6/79, p = 0.004). Fractures occurred 4.0 years (range 0–12 years) after cancer diagnosis. Fracture cases had femoral neck bone mineral density (BMD) of 0.72 + 0.12 g/cm2, T-score of −1.2, that is, within the low bone mass range. Fractures most commonly occurred in lower extremities, vertebral, and wrist sites. Hip fractures accounted for 11 % of fractures, occurring at a median age of 61 years. Conclusions: Fractures occur shortly after commencing cancer therapy. Rapid bone loss associated with cancer therapy may precipitate fractures. Fractures occur at relatively higher BMD in BC. Occurrence of fractures in invasive breast cancer raises the possibility of cancer-induced impairment in bone quality.

AB - Summary: This study evaluates the incidence of bone fractures in women with BC.We found that women with invasive breast cancer are at an increased risk for bone fractures, with fractures most commonly occurring at lower extremity and vertebral sites. The risk is further increased in women undergoing cancer therapy. Introduction: Bone loss and fractures in breast cancer have generally been attributed to aromatase inhibitor use. This study assessed the incidence of fractures after invasive breast cancer diagnosis and evaluated bone density and FRAX risk calculation at time of fracture occurrence. Methods: Retrospective cohort study of women with invasive breast cancer [June 2003–December 2011] who participated in an academic hospital based genetic biobank. Demographic and clinical characteristics were abstracted from the electronic medical record (EMR). Results: A total of 422 women with invasive breast cancer were assessed; 79 (28 %) sustained fractures during the observation period; fractures occurred at multiple skeletal sites in 27 cases (116 fractures). The incidence of fractures was 40 per 1000 person-years. Women who sustained fractures were mostly white and had a family history of osteoporosis (36.9 %, p = 0.03) or history of a prior fracture (6/79, p = 0.004). Fractures occurred 4.0 years (range 0–12 years) after cancer diagnosis. Fracture cases had femoral neck bone mineral density (BMD) of 0.72 + 0.12 g/cm2, T-score of −1.2, that is, within the low bone mass range. Fractures most commonly occurred in lower extremities, vertebral, and wrist sites. Hip fractures accounted for 11 % of fractures, occurring at a median age of 61 years. Conclusions: Fractures occur shortly after commencing cancer therapy. Rapid bone loss associated with cancer therapy may precipitate fractures. Fractures occur at relatively higher BMD in BC. Occurrence of fractures in invasive breast cancer raises the possibility of cancer-induced impairment in bone quality.

KW - Breast cancer

KW - Disability

KW - Fractures

KW - Functional status

KW - Morbidity

KW - Women’s health

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