title: Fracture incidence in pre- and postmenopausal women after completion of adjuvant hormonal therapy for breast cancer.
abstract: BACKGROUND
  Although the effect of hormonal therapy (HT) on fracture risk during treatment of breast cancer is established, information about fracture incidence after completion of HT is scarce. In this hospital based observational study we evaluated fracture rates after completion of HT in pre- and postmenopausal women with breast cancer.
  
  
  METHODS
  All women diagnosed with breast cancer in the VieCuri Medical Center between 1998 and 2005 who started adjuvant HT with aromatase inhibitors or tamoxifen were included (n = 289). Data on fracture rate, fracture type and risk factors for fracture after completion of HT were collected.
  
  
  RESULTS
  The overall fracture rate was 12% in pre- and 15% in postmenopausal women respectively during an average follow-up of 3.1 ± 2.9 years. The number of patients with at least one fracture was 41 (14%). There was no difference in fracture rates between different types of HT (P = 0.15). The most common types of fractures were toe/finger fractures in premenopausal- and hip and major fractures in postmenopausal women. Median time to first fracture was shorter in premenopausal women (1.4 years, IQR 0.2-3.5) than in postmenopausal women (2.4 years, IQR 0.7-5.1, P = 0.01). A history of previous fracture was a significant risk factor for fracture in postmenopausal women (HR 3.9, 95% CI 1.3-11.7).
  
  
  CONCLUSIONS
  Fracture rates in the first years after cessation of HT for breast cancer were 12% and 15% for pre- and postmenopausal women respectively. The most common fractures in postmenopausal women were hip and major fractures.
authors.affiliation: Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands. Electronic address: C.Koopal@umcutrecht.nl.
authors.forename: C
authors.initials: C
authors.lastname: Koopal
authors.affiliation: Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, The Netherlands; Department of Medical Oncology, Maastricht University Medical Center, GROW - School for Oncology and Developmental Biology, Maastricht, The Netherlands.
authors.forename: M L
authors.initials: ML
authors.lastname: Janssen-Heijnen
authors.affiliation: Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands; Department of Medical Oncology, VieCuri Medical Center, Venlo, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: van de Wouw
authors.affiliation: Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands; Faculty of Medicine, University Hasselt, Belgium; NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: van den Bergh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D005260:Female; D050278:Finger Phalanges / Q000293:injuries; D050723:Fractures, Bone / Q000453:epidemiology*; D006620:Hip Fractures / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D017698:Postmenopause; D017697:Premenopause; D012189:Retrospective Studies; D013629:Tamoxifen / Q000627:therapeutic use*; D050277:Toe Phalanges / Q000293:injuries
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D013629:Tamoxifen
keywords: Adjuvant hormonal therapy; Bone fracture; Breast cancer; Fracture risk; Menopause