Robinson P J, Bell R J, Zecena Morales C S, Fradkin P, Davis S R
Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Level 6 The Alfred Centre, 99 Commercial Road, Melbourne, Victoria, 3004, Australia,
Osteoporos Int. 2015 Feb;26(2):795-800. doi: 10.1007/s00198-014-2945-5. Epub 2014 Oct 31.
Minimal-trauma fracture is an important issue in breast cancer survivors, especially rib fracture. The likelihood of fracture is affected by menopausal status and a diagnosis of osteoporosis prior to breast cancer. Most women reported at least one assessment of bone mineral density.
We have investigated the self-reported frequency and pattern of minimal-trauma fracture (MTF) in breast cancer (BC) survivors at least 5 years from diagnosis, along with the use of bone mineral density (BMD) assessment.
This study was carried out within the Bupa Health Foundation Health and Wellbeing After Breast Cancer Study which is a questionnaire-based prospective cohort study of 1683 women diagnosed with their first invasive breast cancer between 2004 and 2006 and followed for at least 5 years.
One thousand two hundred and five women, who remained free of recurrence or new breast cancer, completed the fifth annual follow-up. One hundred sixty-four (13.6%) reported at least one MTF. Rib fracture was the most common (52 fractures in 46 women). Compared with women who remained pre-/peri-menopausal, either being postmenopausal at diagnosis (OR 3.53, 95% Confidence Interval (CI) 1.09-11.44, p=0.036) or changing from pre- to postmenopausal during follow-up (OR 3.97, 95% CI 1.21-13.10, p=0.023) was associated with a higher likelihood of fracture, as was having a diagnosis of osteoporosis at the time of diagnosis (OR 1.74, 95% CI 1.00-2.99, p=0.047). Most women (64.9%) reported at least one BMD assessment.
Overall MTF is a problem for breast cancer survivors, with rib fracture a particular issue for women in our study. Both pre-existing osteoporosis and being postmenopausal are risk factors for subsequent MTF in women treated for breast cancer. Clinicians need to be mindful of fracture prevention medication in these groups.
微小创伤骨折是乳腺癌幸存者中的一个重要问题，尤其是肋骨骨折。骨折的可能性受绝经状态以及乳腺癌确诊前骨质疏松诊断的影响。大多数女性报告至少进行过一次骨密度评估。
我们调查了乳腺癌（BC）幸存者自确诊至少5年后自我报告的微小创伤骨折（MTF）频率和模式，以及骨密度（BMD）评估的使用情况。
本研究在保柏健康基金会乳腺癌后健康与福祉研究中开展，该研究是一项基于问卷的前瞻性队列研究，研究对象为1683名在2004年至2006年间首次被诊断为浸润性乳腺癌且随访至少5年的女性。
1205名无复发或新发乳腺癌的女性完成了第五次年度随访。164名（13.6%）报告至少发生过一次微小创伤骨折。肋骨骨折最为常见（46名女性发生52处骨折）。与仍处于绝经前/围绝经期的女性相比，诊断时已绝经（比值比[OR] 3.53，95%置信区间[CI] 1.09 - 11.44，p = 0.036）或随访期间从绝经前转变为绝经后（OR 3.97，95% CI 1.21 - 13.10，p = 0.023）与骨折可能性较高相关，诊断时患有骨质疏松症也是如此（OR 1.74，95% CI 1.00 - 2.99，p = 0.047）。大多数女性（64.9%）报告至少进行过一次骨密度评估。
总体而言，微小创伤骨折是乳腺癌幸存者面临的一个问题，在我们的研究中肋骨骨折是女性的一个特殊问题。既往存在的骨质疏松症和绝经后状态都是接受乳腺癌治疗女性后续发生微小创伤骨折的危险因素。临床医生需要关注这些人群的骨折预防用药。
