title: Fracture risk and adjuvant therapies in young breast cancer patients: a population-based study.
abstract: BACKGROUND
  Breast cancer survivors have an increased risk of bone fracture. But the risk among young patients with adjuvant therapies remains unknown. This population-based study is aimed to assess the incidence and risk of fracture among young (age of 20 to 39 years) breast cancer patients who received adjuvant therapies.
  
  
  METHODS
  From January 2001 to December 2007, 5,146 newly diagnosed breast cancer patients were enrolled from the National Health Insurance Research Database (NHIRD) in Taiwan. Patients were observed for a maximum of 6 years to determine the incidence of newly onset fracture. Kaplan Meier and Cox regression analyses were used to evaluate the risk of fracture in young breast cancer patients who received adjuvant treatments.
  
  
  RESULTS
  Of the total 5,146 young (age of 20 to 39 years) breast cancer patients, the Cox multivariate proportional hazards analysis showed that AIs, radiotherapy, and monoclonal antibodies were significantly associated with a high risk of fracture. Moreover, patients who received AIs for more than 180 days had a high hazard ratio (HR) of 1.77 (95% CI = 0.68-4.57), and patients who received more than four radiotherapy visits had a high HR of 2.54 (95% CI = 1.07-6.06). Under the site-specific analysis, young breast cancer patients who received AIs had the highest risk of hip fracture (HR = 8.520, 95% CI = 1.711-42.432, p < 0.04), whereas patients who received radiotherapy had the highest risk of vertebral fracture (HR = 5.512, 95% CI = 1.847-16.451, p < 0.01).
  
  
  CONCLUSIONS
  Young breast cancer patients who are receiving AIs, radiotherapy or monoclonal antibody need to be more careful for preventing fracture events. Breast cancer treatment plans are suggested to incorporate fracture prevention interventions.
authors.affiliation: China Medical University Hospital, Taichung, Taiwan, R.O.C; Institute of Clinical Medicine, China Medical University, Taichung, Taiwan, R.O.C.
authors.forename: Chun-Hung
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Department of Psychiatry, Mackay Memorial Hospital Taitung Branch, Taitung, R.O.C; Institute of Medical Sciences, Tzu Chi university, Hualien, Taiwan, R.O.C.
authors.forename: Shaw-Ji
authors.initials: SJ
authors.lastname: Chen
authors.affiliation: Biostatistical Consulting Lab, Institute of Nursing-Midwifery, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, R.O.C.
authors.forename: Chieh-Yu
authors.initials: CY
authors.lastname: Liu
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D047072:Aromatase Inhibitors / Q000009:adverse effects; D001943:Breast Neoplasms / Q000150:complications* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003131:Combined Modality Therapy; D016208:Databases, Factual; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000453:epidemiology; D006620:Hip Fractures / Q000150:complications; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016016:Proportional Hazards Models; D011878:Radiotherapy / Q000009:adverse effects*; D012307:Risk Factors; D016103:Spinal Fractures / Q000150:complications; D013624:Taiwan; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D047072:Aromatase Inhibitors