title: Cancer therapy associated bone loss: implications for hip fractures in mid-life women with breast cancer.
abstract: OBJECTIVE
  Aromatase inhibitors (AIs) have been recently associated with hip fractures. We present a case series of breast cancer survivors and a systematic review of bone health care in breast cancer.
  
  
  METHODS
  We completed clinical assessments and bone density testing (BMD) of hip fractures from January 2005 to December 2008. Prefracture and 12-month functional status was obtained. Systematic review included case reports and review of MEDLINE, PubMed, EMBASE, and Food and Drug Administration Adverse Event Reporting System (FDA AERS) from January 1998 to December 2008 (search terms: breast cancer, bone loss, osteopenia, osteoporosis, malignancy, cancer treatment, menopause, adriamycin, cytoxan, tamoxifen, and AIs).
  
  
  RESULTS
  Median age was 53.5 years; five women had osteopenia, one osteoporosis. Five cases were ER (+), and received surgery, XRT chemotherapy, and anastrozole. Functional decline was noted at 12 months, with difficulty in performing heavy housekeeping, climbing stairs, and shopping. The FDA AERS database included 228 cases of fractures associated with breast cancer therapy; 77/228 (29.4%) were hip or femur fractures. Among mid-life women under the age of 64 years there were 78 fractures; 15/228 (19%) were hip and femur fractures. AIs were the most common drug class associated with fractures (n = 149, 65%).
  
  
  CONCLUSIONS
  Cancer treatment induced bone loss results in hip fractures among mid-life women with breast cancer. Hip fractures occur at younger ages and higher BMD than expected for patients in this age group without breast cancer. Hip fractures result in considerable functional decline. Greater awareness of this adverse drug effect is needed.
authors.affiliation: Bone Health and Osteoporosis Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. bje168@northwestern.edu
authors.forename: Beatrice J
authors.initials: BJ
authors.lastname: Edwards
authors.forename: Dennis W
authors.initials: DW
authors.lastname: Raisch
authors.forename: Veena
authors.initials: V
authors.lastname: Shankaran
authors.forename: June M
authors.initials: JM
authors.lastname: McKoy
authors.forename: William
authors.initials: W
authors.lastname: Gradishar
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Bunta
authors.forename: Athena T
authors.initials: AT
authors.lastname: Samaras
authors.forename: Simone N
authors.initials: SN
authors.lastname: Boyle
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
authors.forename: Dennis P
authors.initials: DP
authors.lastname: West
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Guise
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D047072:Aromatase Inhibitors / Q000009:adverse effects; D001851:Bone Diseases, Metabolic / Q000139:chemically induced*; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy; D003520:Cyclophosphamide / Q000009:adverse effects; D004317:Doxorubicin / Q000009:adverse effects; D005260:Female; D006620:Hip Fractures / Q000139:chemically induced*; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced; D017741:Survivors
chemical_list: D000970:Antineoplastic Agents; D047072:Aromatase Inhibitors; D004317:Doxorubicin; D003520:Cyclophosphamide