Fraenkel Merav, Geffen David B, Novack Victor, Shafat Tali, Mizrakli Yuval, Ariad Samuell, Koretz Michael, Norton Larry, Siris Ethel
Endocrine Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Department of Oncology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
NPJ Breast Cancer. 2015 Jul 22;1:15010. doi: 10.1038/npjbcancer.2015.10. eCollection 2015.
An association between higher bone mineral density (BMD) and the diagnosis of breast cancer (BC) has been reported. Data on the risk of osteoporotic fractures in women with BC are conflicting.
The objective of this study was to assess fracture risk adjusted for BMD in women with and without BC, and to assess whether fracture risk in BC patients is attributed to BMD or BC characteristics.
Using electronic medical records of patients who underwent dual energy X-ray absorptiometry BMD studies at Soroka University Medical Center between February 2003 and March 2011, we identified women with subsequent diagnosis of osteoporotic fractures. BC status, demographic, health characteristics, BMD, and other laboratory findings were assessed. In BC patients data on grade, stage, and treatment were collected. Primary outcome was osteoporotic fracture, analyzed by Cox proportional hazards regression models.
During a median follow-up of 4.9 years in 17,110 women with BMD testing (658 BC patients), 1,193 women experienced an osteoporotic fracture (62 in BC and 1,131 in no-BC groups). In multivariate analysis adjusted for age, body mass index (BMI) and BMD, hazard ratio (HR) for any osteoporotic fracture in women with BC was 1.34 (=0.026). BMD was similar among women with and without BC who fractured. BC patients who experienced an osteoporotic fracture had a trend for less-advanced BC, lower rates of chemotherapy treatment, and higher rates of tamoxifen treatment.
BC survivors are at increased risk of an osteoporotic fracture, which is not explained by worse BMD. Chemotherapy or aromatase inhibitors did not contribute substantially to fracture risk among our BC survivors.
已有报道称较高的骨矿物质密度（BMD）与乳腺癌（BC）的诊断之间存在关联。关于BC女性骨质疏松性骨折风险的数据存在矛盾。
本研究的目的是评估有和没有BC的女性经BMD调整后的骨折风险，并评估BC患者的骨折风险是归因于BMD还是BC特征。
利用2003年2月至2011年3月在索罗卡大学医学中心接受双能X线吸收法BMD研究的患者的电子病历，我们确定了随后被诊断为骨质疏松性骨折的女性。评估了BC状态、人口统计学、健康特征、BMD和其他实验室检查结果。收集了BC患者的分级、分期和治疗数据。主要结局是骨质疏松性骨折，通过Cox比例风险回归模型进行分析。
在17110名接受BMD检测的女性（658名BC患者）中，中位随访4.9年期间，1193名女性发生了骨质疏松性骨折（BC组62名，非BC组1131名）。在对年龄、体重指数（BMI）和BMD进行调整的多变量分析中，BC女性发生任何骨质疏松性骨折的风险比（HR）为1.34（=0.026）。发生骨折的有和没有BC的女性之间BMD相似。发生骨质疏松性骨折的BC患者有BC进展程度较低、化疗治疗率较低和他莫昔芬治疗率较高的趋势。
BC幸存者发生骨质疏松性骨折的风险增加，这不能用较差的BMD来解释。化疗或芳香化酶抑制剂对我们的BC幸存者骨折风险没有实质性影响。
