Fracture risk in women with breast cancer: A population-based study

Melton, L. Joseph; Hartmann, Lynn C.; Achenbach, Sara J.; Atkinson, Elizabeth J.; Therneau, Terry M.; Khosla, Sundeep

doi:10.1002/jbmr.1556

Cited by 40 publications

(32 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This finding likely reflects the use of these skeletal anti‐resorptive agents in patients identified clinically to be at sufficiently high risk for fracture development and likely reflects confounding by indication. Analogous findings have been previously observed in studies on patients with breast cancer treated with bisphosphonate therapy …”

Section: Discussionsupporting

confidence: 88%

Incidence and predictors of osteoporotic fractures in patients with Barrett's oesophagus: a population‐based nested case‐control study

Kumar

Drake

Schleck

et al. 2017

Aliment Pharmacol Ther

View full text Add to dashboard Cite

Summary BACKGROUND Proton pump inhibitors (PPI) are inconsistently associated with osteoporotic fractures. Barrett’s oesophagus patients are treated with high PPI doses for prolonged periods, but there is limited data on the incidence of osteoporosis and fractures in them. AIM In this study, we aimed to estimate the incidence of (and risk factors for) low bone mass (osteoporosis and/or osteopenia) related fractures in a population-based Barrett’s oesophagus cohort. METHODS All subjects with Barrett’s oesophagus and a diagnosis of osteoporosis and fractures were identified using Rochester Epidemiology Project (REP) resources. The incidence rates of all and osteoporotic fractures in these subjects were compared to an age- and gender similar population in Olmsted County to determine standardized incidence ratios (SIR). Predictors were assessed using Cox proportional hazards models. RESULTS Five hundred and twenty-one patients were included [median (IQR) age 61(52, 72) years; three hundred ninety-eight (76%) men] of whom one hundred thirteen (21.7%) had fractures, and forty-six (8.8%) had osteoporotic fractures. The incidence of all fractures and osteoporotic fractures was comparable to that of an age- and gender- matched population (SIR 1.09; 95% CI 0.92–1.29: SIR 1.05; 95% CI 0.85–1.29). PPI use, dose or duration of use was not associated with osteoporotic fracture risk (HR 0.87; 95% CI 0.12–6.39). Independent risk factors for osteoporotic fractures included older age, female gender and higher co-morbidity index. CONCLUSIONS The incidence of osteoporotic fractures was not increased in Barrett’s oesophagus patients compared to the general population. Additionally, PPI use was not associated with increased fracture risk regardless of the duration of therapy or dose.

show abstract

Section: Discussionsupporting

confidence: 88%

Incidence and predictors of osteoporotic fractures in patients with Barrett's oesophagus: a population‐based nested case‐control study

Kumar

Drake

Schleck

et al. 2017

Aliment Pharmacol Ther

View full text Add to dashboard Cite

show abstract

“…Still, some previous observational studies were unable to show a significantly increased risk of bone fracture in women with a previous breast cancer (Melton et al , 2012; Pawloski et al , 2013). An increased risk of bone fractures as compared with the general population was nonetheless found in other hormone-dependent tumours (Melton et al , 2011; Thorstenson et al , 2012).…”

Section: Discussionmentioning

confidence: 96%

Risk of hospitalisation and death due to bone fractures after breast cancer: a registry-based cohort study

Colzani¹,

Clements²,

Johansson³

et al. 2016

Br J Cancer

View full text Add to dashboard Cite

show abstract

“…Fractures were classified as fragility (eg, fractures resulting from low or no trauma) or other type. 20 …”

Section: Methodsmentioning

confidence: 99%

Effects of adjuvant exemestane versus anastrozole on bone mineral density for women with early breast cancer (MA.27B): a companion analysis of a randomised controlled trial

Goss

Hershman

Cheung

et al. 2014

The Lancet Oncology

Self Cite

View full text Add to dashboard Cite

Summary Background Treatment of breast cancer with aromatase inhibitors is associated with damage to bones. NCIC CTG MA.27 was an open-label, phase 3, randomised controlled trial in which women with breast cancer were assigned to one of two adjuvant oral aromatase inhibitors—exemestane or anastrozole. We postulated that exemestane—a mildly androgenic steroid—might have a less detrimental effect on bone than non-steroidal anastrozole. In this companion study to MA.27, we compared changes in bone mineral density (BMD) in the lumbar spine and total hip between patients treated with exemestane and patients treated with anastrozole. Methods In MA.27, postmenopausal women with early stage hormone (oestrogen) receptor-positive invasive breast cancer were randomly assigned to exemestane 25 mg versus anastrozole 1 mg, daily. MA.27B recruited two groups of women from MA.27: those with BMD T-scores of –2·0 or more (up to 2 SDs below sex-matched, young adult mean) and those with at least one T-score (hip or spine) less than –2·0. Both groups received vitamin D and calcium; those with baseline T-scores of less than –2·0 also received bisphosphonates. The primary endpoints were percent change of BMD at 2 years in lumbar spine and total hip for both groups. We analysed patients according to which aromatase inhibitor and T-score groups they were allocated to but BMD assessments ceased if patients deviated from protocol. This study is registered with ClinicalTrials.gov, NCT00354302. Findings Between April 24, 2006, and May 30, 2008, 300 patients with baseline T-scores of –2·0 or more were accrued (147 allocated exemestane, 153 anastrozole); and 197 patients with baseline T-scores of less than –2·0 (101 exemestane, 96 anastrozole). For patients with T-scores greater than –2·0 at baseline, mean change of bone mineral density in the spine at 2 years did not differ significantly between patients taking exemestane and patients taking anastrozole (−0·92%, 95% CI −2·35 to 0·50 vs −2·39%, 95% CI −3·77 to –1·01; p=0·08). Respective mean loss in the hip was −1·93% (95% CI −2·93 to –0·93) versus −2·71% (95% CI −4·32 to –1·11; p=0·10). Likewise for those who started with T-scores of less than –2·0, mean change of spine bone mineral density at 2 years did not differ significantly between the exemestane and anastrozole treatment groups (2·11%, 95% CI −0·84 to 5·06 vs 3·72%, 95% CI 1·54 to 5·89; p=0·26), nor did hip bone mineral density (2·09%, 95% CI −1·45 to 5·63 vs 0·0%, 95% CI −3·67 to 3·66; p=0·28). Patients with baseline T-score of –2·0 or more taking exemestane had two fragility fractures and two other fractures, those taking anastrozole had three fragility fractures and five other fractures. For patients who had baseline T-scores of less than –2·0 taking exemestane, one had a fragility fracture and four had other fractures, whereas those taking anastrozole had five fragility fractures and one other fracture. Interpretation Our results demonstrate that adjuvant treatment with aromatase inhibitors can be considered for breast canc...

show abstract

Fracture risk in women with breast cancer: A population-based study

Cited by 40 publications

References 58 publications

Incidence and predictors of osteoporotic fractures in patients with Barrett's oesophagus: a population‐based nested case‐control study

Incidence and predictors of osteoporotic fractures in patients with Barrett's oesophagus: a population‐based nested case‐control study

Risk of hospitalisation and death due to bone fractures after breast cancer: a registry-based cohort study

Effects of adjuvant exemestane versus anastrozole on bone mineral density for women with early breast cancer (MA.27B): a companion analysis of a randomised controlled trial

Contact Info

Product

Resources

About