title: Femur fracture classification in women with a history of breast cancer.
abstract: OBJECTIVE
  Women with breast cancer are at increased risk for femur fracture. Contributing factors include estrogen deficiency, cancer-related therapies, or direct bone involvement. This study examines fracture subtypes in women with prior breast cancer experiencing a femur fracture.
  
  
  METHODS
  Women age ≥50 years old with a history of invasive breast cancer who experienced a femur fracture were identified during 2005-2012. Fracture site was classified by hospital diagnosis (for hip) and/or radiologic findings (for femoral diaphysis), with subtype classification as pathologic, atypical or fragility fracture. Clinical characteristics were ascertained using health plan databases and disease registries.
  
  
  RESULTS
  There were 802 women with prior breast cancer who experienced a femur fracture. The mean age at fracture was 80.5±9.6 years, with most fractures (93.8%) occurring in the hip and only 6.2% in the femoral diaphysis. However, diaphyseal fractures accounted for 23.6% of fractures in younger women (age ≤65 years). Pathologic fractures comprised 9.6% of total fractures (56.0% of diaphyseal fractures) and accounted for half the fractures in younger women. An atypical fracture pattern was seen in 1% of all femur fractures and 16.0% of diaphyseal fractures, with prior bisphosphonate exposure in all atypical fracture cases.
  
  
  CONCLUSIONS
  Most femur fractures in women with prior breast cancer occurred in the hip. Among younger women and those experiencing diaphyseal fractures, a larger proportion were pathologic and some were found to be atypical. Further studies should examine risk factors for femur fracture in women with breast cancer with specific attention to fracture subtype and pharmacologic exposures.
authors.affiliation: Department of Medicine, Kaiser Permanente Oakland Medical Center, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Chau
authors.affiliation: Division of Research, Kaiser Permanente Northern California, USA.
authors.forename: Malini
authors.initials: M
authors.lastname: Chandra
authors.affiliation: Department of Orthopedic Surgery, Kaiser Permanente Oakland Medical Center, USA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Grimsrud
authors.affiliation: Division of Research, Kaiser Permanente Northern California, USA.
authors.forename: Joel R
authors.initials: JR
authors.lastname: Gonzalez
authors.affiliation: Pharmacy Outcomes Research Group, Kaiser Permanente California, Oakland, CA, USA.
authors.forename: Rita L
authors.initials: RL
authors.lastname: Hui
authors.affiliation: Department of Medicine, Kaiser Permanente Oakland Medical Center, USA; Division of Research, Kaiser Permanente Northern California, USA.
authors.forename: Joan C
authors.initials: JC
authors.lastname: Lo
keywords: Atypical; Breast cancer; Femur; Fracture; Hip; Pathologic