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Comparative Study
. 2010 Feb 16;102(4):645-50.
doi: 10.1038/sj.bjc.6605548. Epub 2010 Jan 19.

Assessment of Fracture Risk in Women With Breast Cancer Using Current vs Emerging Guidelines

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Free PMC article
Comparative Study

Assessment of Fracture Risk in Women With Breast Cancer Using Current vs Emerging Guidelines

P Hadji et al. Br J Cancer. .
Free PMC article

Abstract

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(+)) 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(+) 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.

Figures

Figure 1
Figure 1
Prevalence of osteopenia and osteoporosis at (A) lumbar–spine and (B) total-hip in women with estrogen-receptor (ER)-positive breast cancer.
Figure 2
Figure 2
Prevalence of osteopenia and osteoporosis at the lumbar–spine in (A) premenopausal and (B) postmenopausal women with breast cancer, by estrogen-receptor (ER) status.
Figure 3
Figure 3
(A) Proportion of patients eligible for antiresorptive therapy and (B) estimation of the percentage of fractures prevented based on fracture-risk assessment using current (American Society of Clinical Oncology (ASCO)) and emerging international guidelines. Estimates based on fractures recorded in the National Osteoporosis Risk Assessment (NORA) study (Siris et al, 2004).

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