title: Fracture risk in older, long-term survivors of early-stage breast cancer.
abstract: OBJECTIVE
  To examine the effect of breast cancer and its treatment on fracture risk in older breast cancer survivors.
  
  
  METHODS
  A 10-year prospective cohort study beginning 5 years after a diagnosis of breast cancer for survivors and match date for comparison women.
  
  
  METHODS
  Six integrated healthcare systems.
  
  
  METHODS
  Women aged 65 and older (1,286 survivors, 1,286 comparison women, mean age 77.7 in both groups, white, non-Hispanic: survivors, 81.6%; comparison women, 85.2%) who were alive and recurrence free 5 years after a diagnosis of early-stage breast cancer and matched on age, study site, and enrollment year to a comparison cohort without breast cancer.
  
  
  METHODS
  Cox proportional hazards models were used to estimate the association between fracture risk and survivor-comparison status, adjusting for drugs and risk factors associated with bone health. A subanalysis was used to evaluate the association between tamoxifen exposure and fracture risk.
  
  
  RESULTS
  No difference was observed in fracture rates between groups (hazard ratio (HR) = 1.1, 95% confidence interval (CI) = 0.9-1.3). The protective effect of tamoxifen was not statistically significant (HR = 0.9, 95% CI = 0.6-1.2).
  
  
  CONCLUSIONS
  Long-term survivors of early-stage breast cancer diagnosed at age 65 and older are not at greater risk of osteoporotic fractures than age-matched women without breast cancer. There appears to be no long-term protection from fractures with tamoxifen use.
authors: HealthPartners Institute for Education and Research, Minneapolis, Minnesota.
authors: Pamala A
authors: PA
authors: Pawloski
authors: Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors: Ann M
authors: AM
authors: Geiger
authors: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California.
authors: Reina
authors: R
authors: Haque
authors: Group Health Research Institute, Seattle, Washington.
authors: Aruna
authors: A
authors: Kamineni
authors: Meyers Primary Care Institute, Worcester, Massachusetts.
authors: Hassan
authors: H
authors: Fouayzi
authors: Meyers Primary Care Institute, Worcester, Massachusetts.
authors: Jessica
authors: J
authors: Ogarek
authors: Lovelace Respiratory Research Institute, Albuquerque, New Mexico.
authors: Hans V
authors: HV
authors: Petersen
authors: Dana-Farber Cancer Institute, Phyllis F. Cantor Center, Boston, Massachusetts.|Section of Geriatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts.
authors: Jaclyn L F
authors: JLF
authors: Bosco
authors: Section of Geriatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts.|Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Healthcare System, Boston, Massachusetts.
authors: Soe Soe
authors: SS
authors: Thwin
authors: Section of Geriatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts.
authors: Rebecca A
authors: RA
authors: Silliman
authors: Meyers Primary Care Institute, Worcester, Massachusetts.
authors: Terry S
authors: TS
authors: Field
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology; D018572:Disease-Free Survival; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D017741:Survivors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
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