Objectives
Evaluate the differences with densitometry after 2 years of treatment in patients with breast cancer and a high risk fracture.
Methods
A 2 year duration longitudinal study was done in patients diagnosed with breast cancer sent to the Rheumatology Osteoporosis Unit in Hosptial d’Ontinyent, and required supplements of calcium and vitamin D ± bisphosphonates after a risk fracture study. A register and description of the socio-demographic data was done, as well as the characteristics of the breast tumor, the risk factors of osteoporosis and fragile fractures, the definite diagnosis and the treatment initiated in these patients. Differences between the mean values obtained in the mineral bone density of lumbar, total femoral, and femoral neck, were evaluated with the t-student study. The statistic system employed was SPSS 17.0.
Results
41 patients were studied, with an average age of 59 years old (37 - 79 years).All of them had a unilateral breast cancer, while none had metastases.The treatments received were: radical mastectomy (61%), radiotherapy (61%), chemotherapy (78%), hormonotherapy (29%), tamoxifen (51%), GnRH analogues (12%) and aromatase inhibitors (88%). Risk factors for osteoporosis are shown on table 1. High risk osteoporosis was diagnosed in 3 patients (7.3%), osteoporosis in 15 patients (36.6%) and osteopenia in 23 patients (56.1%).In spinal x-rays, 49 patients had ≥1 vertebral collapse and 7 of them ≥1 vertebral fracture.Treatment with supplements of calcium and vitamin D was initiated in all patients, and bisphosphonates (either oral or i.v.) in 34 patients, as follow: ibandronate (in 13), risedronate (in 15), alendronate (in 5) and zoledronate (in the remaining one).After 2 years of follow-up, no patient had developed metastases and 82.9% continued with aromatase inhibitors. No patient suffered new vertebral collapse or fracture, and only 1 patient suffered from other fractures. After a 2 year treatment of osteoporosis, 95.1% of the patients continued with the same treatment, and only 2 patients had abandoned it. Results obtained from densitometry pre-treatment and after 2 year treatment, as well as statistical differences by applying t-student test, are shown on table 2.
Table 1. Risk factors for osteoporosis in patients with breast cancer and fragile risk fracture
Factorn%Factorn%
Early menopause1128.2Medical History hip fracture00
Induced menopause1741.5Medical History other fractures37.3
BMI <22512.5Family Diseases osteoporosis1024.4
Medical History ≥1 fracture819.5Family Diseases hip fracture1126.8
Medical History vertebral fractures12.4Corticosteroid Treatment24.9
Medical History Colles fracture49.8Smoking24.9
Table 2. Values obtained from bone densitometry (mean, standard deviation) and statistical differences
DXALumbarFemoral NeckFemoral Total
DMO basal0.933±0.080.832±0.100.870±0.11
DMO 2 years0.959±0.090.850±0.100.883±0.10
p0.0150.0160.016
Conclusions
Patients with breast cancer that require initiating treatment for fragile risk fracture present good treatment compliance. Tr...
