title: Elevated incidence of fractures in women with invasive breast cancer.
abstract: This study evaluates the incidence of bone fractures in women with BC.We found that women with invasive breast cancer are at an increased risk for bone fractures, with fractures most commonly occurring at lower extremity and vertebral sites. The risk is further increased in women undergoing cancer therapy.
  
  
  BACKGROUND
  Bone loss and fractures in breast cancer have generally been attributed to aromatase inhibitor use. This study assessed the incidence of fractures after invasive breast cancer diagnosis and evaluated bone density and FRAX risk calculation at time of fracture occurrence.
  
  
  METHODS
  Retrospective cohort study of women with invasive breast cancer [June 2003-December 2011] who participated in an academic hospital based genetic biobank. Demographic and clinical characteristics were abstracted from the electronic medical record (EMR).
  
  
  RESULTS
  A total of 422 women with invasive breast cancer were assessed; 79 (28 %) sustained fractures during the observation period; fractures occurred at multiple skeletal sites in 27 cases (116 fractures). The incidence of fractures was 40 per 1000 person-years. Women who sustained fractures were mostly white and had a family history of osteoporosis (36.9 %, p = 0.03) or history of a prior fracture (6/79, p = 0.004). Fractures occurred 4.0 years (range 0-12 years) after cancer diagnosis. Fracture cases had femoral neck bone mineral density (BMD) of 0.72 + 0.12 g/cm(2), T-score of -1.2, that is, within the low bone mass range. Fractures most commonly occurred in lower extremities, vertebral, and wrist sites. Hip fractures accounted for 11 % of fractures, occurring at a median age of 61 years.
  
  
  CONCLUSIONS
  Fractures occur shortly after commencing cancer therapy. Rapid bone loss associated with cancer therapy may precipitate fractures. Fractures occur at relatively higher BMD in BC. Occurrence of fractures in invasive breast cancer raises the possibility of cancer-induced impairment in bone quality.
authors: Department of General Internal Medicine, University of Texas, MD Anderson Cancer Center, 1515 Holcombe, unit 1465, Houston, TX, 77030, USA. bedwards@mdanderson.org.
authors: B J
authors: BJ
authors: Edwards
authors: Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA.|Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors: W J
authors: WJ
authors: Gradishar
authors: NUgene Project, Center for Genetic Medicine, Northwestern University, Chicago, IL, USA.
authors: M E
authors: ME
authors: Smith
authors: NUgene Project, Center for Genetic Medicine, Northwestern University, Chicago, IL, USA.
authors: J A
authors: JA
authors: Pacheco
authors: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors: J
authors: J
authors: Holbrook
authors: Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA.|Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors: J M
authors: JM
authors: McKoy
authors: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors: B
authors: B
authors: Nardone
authors: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors: S
authors: S
authors: Tica
authors: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors: V
authors: V
authors: Godinez-Puig
authors: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors: A W
authors: AW
authors: Rademaker
authors: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors: I B
authors: IB
authors: Helenowski
authors: Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors: A D
authors: AD
authors: Bunta
authors: Department of Molecular Pharmacology and Biological Chemistry, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors: P H
authors: PH
authors: Stern
authors: Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA.|Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors: S T
authors: ST
authors: Rosen
authors: Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA.|Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors: D P
authors: DP
authors: West
authors: Department of Medicine, Division of Endocrinology, Indiana University, Indianapolis, IN, USA.
authors: T A
authors: TA
authors: Guise
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D015519:Bone Density / Q000502:physiology; D001943:Breast Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D015994:Incidence; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010024:Osteoporosis / Q000453:epidemiology / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents
keywords: Breast cancer; Disability; Fractures; Functional status; Morbidity; Women’s health