title: Differentiating the Causes of Spontaneous Rib Fracture After Breast Cancer.
abstract: Spontaneous rib fracture after treatment for primary breast cancer is not uncommon. Although metastatic disease accounts for about 30% of spontaneous rib fractures and should constitute the first line of diagnostic investigation, other possible contributors include primary osteoporosis or secondary osteoporosis resulting from cancer treatments. Chemotherapy-induced menopause, aromatase inhibitors, radiation therapy, and long-term bisphosphonate use can all contribute to bone fragility, including spontaneous rib fractures in the latter 3. Drawing on recent breast cancer practice guidelines as well as population-based studies of fracture risk for women with a history of breast cancer and systematic reviews, this Perspective will provide an update on recent developments in understanding how to differentiate the possible reasons for non-traumatic rib fracture in women treated for breast cancer. In addition to describing the various possible causes of spontaneous rib fracture, the recommended medical and imaging procedures for differentiating among the potential causes will be presented.
authors: Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia. Electronic address: susan.harris@ubc.ca.
authors: Susan R
authors: SR
authors: Harris
mesh_terms: D000367:Age Factors; D047072:Aromatase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D001706:Biopsy; D015519:Bone Density / Q000187:drug effects / Q000528:radiation effects; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008594:Menopause, Premature / Q000187:drug effects; D010024:Osteoporosis / Q000139:chemically induced / Q000150:complications* / Q000000981:diagnostic imaging; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000000981:diagnostic imaging; D016649:Primary Ovarian Insufficiency / Q000139:chemically induced / Q000150:complications; D011878:Radiotherapy / Q000009:adverse effects*; D012253:Rib Fractures / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed
chemical_list: D047072:Aromatase Inhibitors; D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Aromatase inhibitors; Bone fragility; Differential diagnosis; Metastasis; Radiation fibrosis