The effect of age and bone mineral density on the absolute, excess, and relative risk of fracture in postmenopausal women aged 50–99: results from the National Osteoporosis Risk Assessment (NORA)

Siris, Ethel S.; Brenneman, Susan K.; Barrett‐Connor, Elizabeth; Miller, Paul D.; Sajjan, Shiva; Berger, Marc L.; Chen, Y.-T.

doi:10.1007/s00198-005-0027-4

Cited by 231 publications

(151 citation statements)

References 49 publications

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“…38,39 Studies on physical activity for CTIBL in women with breast cancer P Hadji osteoporosis prevention have shown diverse results on BMD. 40,41 A case-control study showed a delay in the loss of BMD in 66 pre and postmenopausal women with BC using either aerobic ( À 0.8%) or weight training ( À 4.9%) compared with controls. 42 In the current guidelines (ESMO, DVO), the level of evidence and the degree of recommendation arestill low (4/C).…”

Section: Practical Aspects Of the Treatment Of Ctiblmentioning

confidence: 99%

Cancer Treatment-Induced Bone Loss in women with breast cancer

Hadji

2015

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Osteoporosis is one of the most frequent diseases in postmenopausal women, leading to an increased fracture risk due to the physiologic loss of the bone protective effects of estrogen. Hereby, several risk factors for fracture such as prevalent fracture, low bone mineral density (BMD), age, low body mass index, family history, tendency to falls, smoking, use of SSRIs, glucocorticoid use etc. have been identified. In addition, the further reduction in endogenous estrogens with chemotherapy (CHT), GnRH analoga or aromatase inhibitors (AIs) continuously increases fracture risk. Breast cancer (BC) on the other hand is the most frequent cancer type in women. Recent reports indicate a continuous increased incidence, whereas mortality, due to early diagnosis and treatment improvements, is decreasing. Dependent on specific tumor characteristics, radiation, CHT, antibody treatment as well as endocrine treatment have been included into the adjuvant clinical treatment setting. Some but not all of these cancer-specific treatments interfere with bone turnover, leading to an accelerated bone loss referred to as cancer treatment-induced bone loss (CTIBL). Whereas CHT leads to an unspecific increase in bone resorption, AI reduces residual serum endogenous estrogen level and is associated with a decrease in BMD and increased fracture risk. Independent of the type of AI administered, bone loss is 2-3-fold increased compared with healthy, age-matched postmenopausal controls. Therefore, several guidelines have emerged to help managing CTIBL in women with BC including strategies to identify and treat those at highest risk for fractures. This review summarizes the current knowledge on CTIBL and fracturing risk and indicates preventative strategies.

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Section: Practical Aspects Of the Treatment Of Ctiblmentioning

confidence: 99%

Cancer Treatment-Induced Bone Loss in women with breast cancer

Hadji

2015

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“…Additional data from the NORA study indicate that at least 45% of fractures occur in women with two or more fracture risk factors. It is important to note that our estimates of fracture prevention are based on fracture risk in healthy women (Siris et al, 2006) and might therefore underestimate the true protective effect of bisphosphonates in the BC setting.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, LS osteoporosis was also more prevalent in postmenopausal patients with ER þ vs ER -BC (3.1 vs 1.3%; Figure 2B). The prevalence of clinical factors associated with increased fracture risk independent of BMD is presented in Table 2 (Cummings et al, 1995;Kanis et al, 2005Kanis et al, , 2007Siris et al, 2006;Hadji et al, 2008). Except for age (465 years), history of smoking (B28%), and AI therapy (B30%), each validated fracture risk factor had low prevalence (o6%) among postmenopausal patients with ER þ BC; however, 44.4% of these patients had T-scores oÀ1.5.…”

Section: Prevalence Of Osteopenia Osteoporosis and Fracture Risk Famentioning

confidence: 99%

“…However, selecting patients with two or more clinical risk factors (including T-score oÀ1.5) identified a somewhat larger proportion of patients (28.6%) who would be eligible for treatment ( Figure 3A) (Siris et al, 2004). Based on NORA fracture incidence data from 170 083 women (Siris et al, 2006), limiting bisphosphonate treatment according to current ASCO guidelines is estimated to prevent only 18% of potential fractures, whereas treatment based on emerging international guidelines would prevent approximately 45% of potential fractures ( Figure 3B) (Siris et al, 2004).…”

Section: 3mentioning

confidence: 99%

“…Unfortunately, DXA scanning of all patients might not be feasible in some settings. However, additional factors, including family and personal history of fragility fractures, age, long-term medications such as corticosteroids, low body mass index (BMI), and smoking, have all been associated with an increased fracture risk that is independent of BMD (Cummings et al, 1995;Kanis et al, 2005Kanis et al, , 2007Siris et al, 2006). To place BMD and other risk factors in the context of identifying women with BC who are at increased risk of fracture and are likely to benefit most from bisphosphonate therapy, a panel of experts recently evaluated data from large clinical trials in postmenopausal women and women with BC to develop international guidelines for using clinical risk factors for fracture along with BMD measurements (when available) .…”

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confidence: 99%

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Assessment of fracture risk in women with breast cancer using current vs emerging guidelines

et al. 2010

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BACKGROUND: Breast cancer (BC) therapies can have negative effects on bone. Current guidelines recommend antiresorptive therapy based on bone mineral density (BMD), and emerging guidelines include both clinical risk factors and BMD to assess the overall fracture risk. A retrospective, case -controlled study based on current and emerging guidelines was conducted in women with newly diagnosed BC to identify those who were at increased fracture risk based on current and emerging guidelines. METHODS: Baseline characteristics, fracture risk factors, and lumbar -spine (LS) and total-hip BMD in women with BC (88 premenopausal and 402 postmenopausal) were assessed to determine who would receive bisphosphonate therapy based on current and emerging guidelines. RESULTS: Among patients with estrogen-receptor-positive (ER þ ) BC, 18.8% of premenopausal and 36.9% of postmenopausal women were osteopenic at LS. In the postmenopausal cohort, osteoporosis was more prevalent in patients with ER þ vs ER -BC. Current guidelines identified 8.9% of patients as eligible for antiresorptive therapy, clinical risk factors alone identified 6.5%, and BMD plus clinical risk factors identified 28.6%. CONCLUSIONS: In addition to fracture risk factors present at BC diagnosis, cancer therapies leading to BMD loss further increase fracture risk. Evaluating both BMD and clinical risk factors may allow more effective identification of BC patients with elevated fracture risk.

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