title: Assessing the prevalence of compromised bone health among overweight and obese African-American breast cancer survivors: a case-control study.
abstract: OBJECTIVE
  Osteoporosis increases the risk of fracture and is often considered a late effect of breast cancer treatment. We examined the prevalence of compromised bone health in a sample of exclusively African-American (AA) breast cancer survivors since bone mineral density (BMD) varies by race/ethnicity in healthy populations.
  
  
  METHODS
  Using a case-control design, AA women in a weight loss intervention previously diagnosed and treated for stages I-IIIa breast cancer were matched 1:1 on age, race, sex, and BMI with non-cancer population controls (n = 101 pairs) from National Health and Nutrition Examination Survey (NHANES). Questionnaires and dual-energy x-ray absorptiometry (DXA) scanning were completed, and participants were categorized as having normal bone density, low bone mass, or osteoporosis using the World Health Organization (WHO) definition for femoral neck T-scores.
  
  
  RESULTS
  The majority of these overweight/obese survivors were 6.6 (±4.7) years post-diagnosis, had stage II (n = 46) or stage III (n = 16) disease, and treated with chemotherapy (76 %), radiation (72 %), and/or adjuvant hormone therapies (45 %). Mean femoral neck BMD was significantly lower in cases vs. matched non-cancer population controls (0.85 ± 0.15 vs. 0.91 ± 0.14 g/cm(2), respectively; p = 0.007). However, the prevalence of low bone mass and osteoporosis was low and did not significantly differ between groups (n = 101 pairs; p = 0.26), even when restricted to those on adjuvant hormone therapies (n = 45 pairs; p = 0.75). Using conditional logistic regression, controlling for dietary factors and education, the odds of developing compromised bone health in AA breast cancer survivors was insignificant (OR 1.5, 95 % CI 0.52, 5.56).
  
  
  CONCLUSIONS
  These null case-control findings challenge the clinical assumption that osteoporosis is highly prevalent among all breast cancer survivors, providing foundational evidence to support differences by race/ethnicity and body weight.
  
  
  CONCLUSIONS
  Routine bone density testing and regular patient-provider dialogue is critical in overweight/obese AA breast cancer survivors to ensure that healthy lifestyle factors (e.g., ideal weight, regular weight-bearing exercises, dietary adequacy of calcium and vitamin D) support optimal skeletal health.
authors.affiliation: Marcella Niehoff School of Nursing, Health Sciences Campus, Loyola University Chicago, 2160 South First Avenue, Building 105, Room 2852, Maywood, IL, 60153, USA. psheean1@luc.edu.
authors.forename: Patricia
authors.initials: P
authors.lastname: Sheean
authors.affiliation: Takeda Development Center Americas, Inc., One Takeda Parkway, Deerfield, IL, 60015, USA. huifang.liang@takeda.com.
authors.forename: Huifang
authors.initials: H
authors.lastname: Liang
authors.affiliation: Section for Health Promotion Research, Department of Medicine, University of Illinois at Chicago, 1747 West Roosevelt Road, Room 558, MC 275, Chicago, IL, 60608, USA. Ischiff@uic.edu.
authors.forename: Linda
authors.initials: L
authors.lastname: Schiffer
authors.affiliation: Section for Health Promotion Research, Department of Medicine, University of Illinois at Chicago, 1747 West Roosevelt Road, Room 558, MC 275, Chicago, IL, 60608, USA. carroy5@uic.edu.
authors.forename: Claudia
authors.initials: C
authors.lastname: Arroyo
authors.affiliation: Biomedical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA. ktroy@wpi.edu.
authors.forename: Karen
authors.initials: K
authors.lastname: Troy
authors.affiliation: Section for Health Promotion Research, Department of Medicine, University of Illinois at Chicago, 1747 West Roosevelt Road, Room 558, MC 275, Chicago, IL, 60608, USA. mstolley@uic.edu.
authors.forename: Melinda
authors.initials: M
authors.lastname: Stolley
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D015519:Bone Density / Q000502:physiology; D001943:Breast Neoplasms / Q000208:ethnology / Q000401:mortality / Q000534:rehabilitation; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D009749:Nutrition Surveys; D009765:Obesity / Q000150:complications / Q000453:epidemiology* / Q000208:ethnology; D010024:Osteoporosis / Q000150:complications / Q000453:epidemiology* / Q000208:ethnology; D050177:Overweight / Q000150:complications / Q000453:epidemiology* / Q000208:ethnology; D015995:Prevalence; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
keywords: African-American; Bone health; Breast cancer; NHANES; Osteoporosis; Survivor; Vitamin D
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