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Elevated incidence of fractures in women with invasive breast cancer

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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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Acknowledgments

The authors acknowledge Tina Kiguradze for her editorial assistance. All authors of this research paper have directly participated in the planning, execution, or analysis of the study. All authors of this paper have read and approved the final version submitted.

The table below summarizes each author’s role in preparing this manuscript

Authors

Concept/study design

Data collection/interpretation

Drafting manuscript

Critical revision of manuscript

Statistical analysis

Funding

Administrative, technical, or material support

Beatrice J Edwards

Yes

Yes

Yes

Yes

 

Yes

 

William Gradishar

Yes

  

Yes

  

Yes

Jennifer Pacheco

 

Yes

 

Yes

Yes

  

Maureen Smith

 

Yes

Yes

Yes

  

Yes

Jaime Holbrook

  

Yes

Yes

  

Yes

June McKoy

 

Yes

Yes

Yes

  

Yes

Beatrice Nardone

 

Yes

 

Yes

  

Yes

Stefani Tica

 

Yes

Yes

   

Yes

Victoria Godinez Puig

 

Yes

Yes

   

Yes

Alfred Rademaker

Yes

  

Yes

Yes

  

Irene Helenowski

   

Yes

Yes

 

Yes

Andrew D. Bunta

Yes

 

Yes

Yes

  

Yes

Paula Stern

 

Yes

Yes

Yes

  

Yes

Steven Rosen

Yes

Yes

 

Yes

  

Yes

Dennis West

Yes

Yes

 

Yes

 

Yes

Yes

Theresa Guise

  

Yes

Yes

  

Yes

This work was supported by the National Institute of Health [grants 5R01-CA125077-03 (DPW), 3R01CA125077-03S1 (BJE), and 5K01 CA134554-05 (JMM)]. A portion of this work was presented at the Annual Conference on Cancer and Bone in Chicago, December 9–11, 2011, sponsored by the International Bone and Mineral Society (IBMS), and the ASCO Breast Symposium September 6–7, 2013 San Francisco, California.

Funding sources

This work was supported by: National Institute of Health [grants 5R01-A125077-03 (DPW), 3R01CA125077-03S1 (BJE) and 5 K01 CA134554-05 (JMM)].

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of General Internal Medicine, University of Texas, MD Anderson Cancer Center, 1515 Holcombe, unit 1465, Houston, TX, 77030, USA

    B. J. Edwards

  2. Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA

    W. J. Gradishar, J. M. McKoy, S. T. Rosen & D. P. West

  3. Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    A. D. Bunta

  4. Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    W. J. Gradishar, J. M. McKoy, S. Tica & S. T. Rosen

  5. NUgene Project, Center for Genetic Medicine, Northwestern University, Chicago, IL, USA

    M. E. Smith & J. A. Pacheco

  6. Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    J. Holbrook, B. Nardone, V. Godinez-Puig & D. P. West

  7. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    J. M. McKoy, A. W. Rademaker & I. B. Helenowski

  8. Department of Molecular Pharmacology and Biological Chemistry, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    P. H. Stern

  9. Department of Medicine, Division of Endocrinology, Indiana University, Indianapolis, IN, USA

    T. A. Guise

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  1. B. J. Edwards
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  2. W. J. Gradishar
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  3. M. E. Smith
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  4. J. A. Pacheco
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  5. J. Holbrook
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  6. J. M. McKoy
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  7. B. Nardone
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  8. S. Tica
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  9. V. Godinez-Puig
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  10. A. W. Rademaker
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  11. I. B. Helenowski
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  12. A. D. Bunta
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  13. P. H. Stern
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  14. S. T. Rosen
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  15. D. P. West
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  16. T. A. Guise
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Corresponding author

Correspondence to B. J. Edwards.

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Edwards, B.J., Gradishar, W.J., Smith, M.E. et al. Elevated incidence of fractures in women with invasive breast cancer. Osteoporos Int 27, 499–507 (2016). https://doi.org/10.1007/s00198-015-3246-3

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  • DOI: https://doi.org/10.1007/s00198-015-3246-3

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