Assessment of fracture risk in women with breast cancer using current vs emerging guidelines.
BACKGROUND
Breast cancer (BC) therapies can have negative effects on bone. Current guidelines recommend antiresorptive therapy based on bone mineral density (BMD), and emerging guidelines include both clinical risk factors and BMD to assess the overall fracture risk. A retrospective, case-controlled study based on current and emerging guidelines was conducted in women with newly diagnosed BC to identify those who were at increased fracture risk based on current and emerging guidelines.


METHODS
Baseline characteristics, fracture risk factors, and lumbar-spine (LS) and total-hip BMD in women with BC (88 premenopausal and 402 postmenopausal) were assessed to determine who would receive bisphosphonate therapy based on current and emerging guidelines.


RESULTS
Among patients with estrogen-receptor-positive (ER(+)) BC, 18.8% of premenopausal and 36.9% of postmenopausal women were osteopenic at LS. In the postmenopausal cohort, osteoporosis was more prevalent in patients with ER(+) vs ER(-) BC. Current guidelines identified 8.9% of patients as eligible for antiresorptive therapy, clinical risk factors alone identified 6.5%, and BMD plus clinical risk factors identified 28.6%.


CONCLUSIONS
In addition to fracture risk factors present at BC diagnosis, cancer therapies leading to BMD loss further increase fracture risk. Evaluating both BMD and clinical risk factors may allow more effective identification of BC patients with elevated fracture risk.
Hadji
P
P
Department of Endocrinology, Reproductive Medicine, and Osteoporosis, Philipps-University of Marburg, Germany. hadji@med.uni-marburg.de
Ziller
M
M
Albert
U S
US
Kalder
M
M
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use*; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001851:Bone Diseases, Metabolic / Q000453:epidemiology / Q000209:etiology; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D008593:Menopause / Q000187:drug effects / Q000502:physiology; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors
D050071:Bone Density Conservation Agents