Edwards B J, Gradishar W J, Smith M E, Pacheco J A, Holbrook J, McKoy J M, Nardone B, Tica S, Godinez-Puig V, Rademaker A W, Helenowski I B, Bunta A D, Stern P H, Rosen S T, West D P, Guise T A
Department of General Internal Medicine, University of Texas, MD Anderson Cancer Center, 1515 Holcombe, unit 1465, Houston, TX, 77030, USA.
Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA.
Osteoporos Int. 2016 Feb;27(2):499-507. doi: 10.1007/s00198-015-3246-3. Epub 2015 Aug 21.
This study evaluates the incidence of bone fractures in women with BC.We found that women with invasive breast cancer are at an increased risk for bone fractures, with fractures most commonly occurring at lower extremity and vertebral sites. The risk is further increased in women undergoing cancer therapy.
Bone loss and fractures in breast cancer have generally been attributed to aromatase inhibitor use. This study assessed the incidence of fractures after invasive breast cancer diagnosis and evaluated bone density and FRAX risk calculation at time of fracture occurrence.
Retrospective cohort study of women with invasive breast cancer [June 2003-December 2011] who participated in an academic hospital based genetic biobank. Demographic and clinical characteristics were abstracted from the electronic medical record (EMR).
A total of 422 women with invasive breast cancer were assessed; 79 (28 %) sustained fractures during the observation period; fractures occurred at multiple skeletal sites in 27 cases (116 fractures). The incidence of fractures was 40 per 1000 person-years. Women who sustained fractures were mostly white and had a family history of osteoporosis (36.9 %, p = 0.03) or history of a prior fracture (6/79, p = 0.004). Fractures occurred 4.0 years (range 0-12 years) after cancer diagnosis. Fracture cases had femoral neck bone mineral density (BMD) of 0.72 + 0.12 g/cm(2), T-score of -1.2, that is, within the low bone mass range. Fractures most commonly occurred in lower extremities, vertebral, and wrist sites. Hip fractures accounted for 11 % of fractures, occurring at a median age of 61 years.
Fractures occur shortly after commencing cancer therapy. Rapid bone loss associated with cancer therapy may precipitate fractures. Fractures occur at relatively higher BMD in BC. Occurrence of fractures in invasive breast cancer raises the possibility of cancer-induced impairment in bone quality.
本研究评估了乳腺癌女性患者骨折的发生率。我们发现，浸润性乳腺癌女性患者发生骨折的风险增加，骨折最常发生在下肢和脊柱部位。接受癌症治疗的女性风险进一步增加。
乳腺癌患者的骨质流失和骨折通常归因于芳香化酶抑制剂的使用。本研究评估了浸润性乳腺癌诊断后骨折的发生率，并在骨折发生时评估了骨密度和FRAX风险计算。
对2003年6月至2011年12月参与一家学术医院基因生物样本库的浸润性乳腺癌女性患者进行回顾性队列研究。人口统计学和临床特征从电子病历（EMR）中提取。
共评估了422例浸润性乳腺癌女性患者；79例（28%）在观察期内发生骨折；27例（116处骨折）在多个骨骼部位发生骨折。骨折发生率为每1000人年40例。发生骨折的女性大多为白人，有骨质疏松家族史（36.9%，p = 0.03）或既往骨折史（6/79，p = 0.004）。骨折发生在癌症诊断后4.0年（范围0 - 12年）。骨折病例的股骨颈骨密度（BMD）为0.72 ± 0.12 g/cm²，T值为 -1.2，即处于低骨量范围内。骨折最常发生在下肢、脊柱和腕部。髋部骨折占骨折的11%，发生的中位年龄为61岁。
骨折在开始癌症治疗后不久发生。与癌症治疗相关的快速骨质流失可能促使骨折发生。乳腺癌患者骨折时的骨密度相对较高。浸润性乳腺癌患者发生骨折增加了癌症导致骨质质量受损的可能性。
