The Interaction of Lean Body Mass With Fat Body Mass Is Associated With Vertebral Fracture Prevalence in Women With Early Breast Cancer Undergoing Aromatase Inhibitor Therapy

Abstract

Aromatase inhibitors (AIs) induce depletion of estrogen levels, causing bone loss and increased fracture risk in women with breast cancer. High‐fat body mass (FBM) emerged as an independent factor associated with the prevalence of morphometric vertebral fractures (VFs) in patients undergoing AIs. We explored the role of lean body mass (LBM) and the interaction of LBM with FBM in predicting the occurrence of VFs in postmenopausal women who were either AI‐naïve or AI‐treated. A total of 684 consecutive breast cancer patients were enrolled in this cross‐sectional study. Each woman underwent a dual‐energy X‐ray absorptiometry (DXA) scan, measuring bone mineral density (BMD), LBM, and FBM; VFs were assessed using a quantitative morphometric analysis of DXA images. After propensity score matching, the study population was restricted to 480 women, 240 AI‐naïve and 240 AI‐treated. We used multivariable logistic regression models to explore the associations between baseline characteristics, VF prevalence and the interaction between LBM, FBM and AI therapy. No interaction between LBM and AI therapy on VF prevalence was shown. Conversely, we reported a significant interaction between LBM, FBM and AI therapy (p = .0311). Among AI‐treated women having LBM below and FBM above or equal the median value, VF prevalence was numerically higher (15/31; 48.4%) than in other subgroups (VF prevalence: 35.7% in high‐LBM and low‐FBM group, 23.2% in high‐LBM and high‐FBM group, and 19.8% in low‐LBM and low‐FBM group). Among AI‐naïve women, the greatest VF proportion was observed in the subgroup with LBM and FBM below median value (25/92; 27.2%). This study suggests a synergism between LBM and FBM in predicting the morphometric VF in women with early breast cancer undergoing AIs. This observation is new and deserves further investigation. The assessment of body composition by DXA might be useful when estimating fracture risk in this population. © 2020 American Society for Bone and Mineral Research © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.

Prediction of vertebral fractures in cancer patients undergoing hormone deprivation therapies: Reliability of WHO fracture risk assessment tool (FRAX) and bone mineral density in real-life clinical practice

“…From this point of view, high BMI and increased body fat mass are markers of unfavorable outcome in subjects with prostate cancer [28] . An association between body fat mass and vertebral fractures was already reported in women under treatment with AIs [29] , especially when low lean body mass concomitantly decreased [30] . In our population of females with breast cancer under HDT, vertebral fractures were not associated with higher BMI, likely because in most overweight or obese cases, lean body mass did not decrease in relationship with maintained androgen secretion during estrogen-deprivation therapies [4] .…”

Hypovitaminosis D and the endocrine phenotype of COVID-19

“…Low levels of 25OH VD were very frequently found in obese nondiabetic particularly elderly subjects being inversely related to BMI and adiposity [73,108], with negative effects on bone and muscle health. Interestingly, VD deficiency was also reported to be associated with decreased muscle mass and function thereby predisposing to an obese osteosarcopenic phenotype which is also observed in patients with prostate or breast cancer under medical treatment [109,110].…”

An Overview of Systematic Reviews of the Role of Vitamin D on Inflammation in Patients with Diabetes and the Potentiality of Its Application on Diabetic Patients with COVID-19

“…High BMI and altered body composition, with increased adiposity, are reported as independent risk factors for greater disease severity and poor prognosis in COVID-19 patients [ 139 , 140 ]. Interestingly, low levels of 25(OH)D were frequently reported in obese and overweight patients, being inversely related to BMI and adiposity [ 132 , 141 ], negatively influencing skeletal and muscle health, with a resulting increased predisposition to an obese osteosarcopenic phenotype [ 142 , 143 ]. In fact, BMI has also been reported to predict resistance to vitamin D [ 144 ].…”