Relationship between incidence of fracture and health-related quality-of-life in metastatic breast cancer patients with bone metastases

J Med Econ. 2013;16(1):179-89. doi: 10.3111/13696998.2012.737883. Epub 2012 Oct 23.


Objective: This retrospective observational study describes treatment patterns and longitudinal health-related quality-of-life (HRQoL) among metastatic breast cancer patients with bone metastasis from nine community oncology clinics.

Methods: For description of treatment patterns, patients were classified as treated if they started zoledronic acid within 60 days of diagnosis of bone metastasis, were considered untreated if they had not, and were considered unclassified if they died or experienced fracture before 60 days had elapsed. Medical record review provided demographic and disease characteristics as well as history of treatment. Patients completed Patient Care Monitor (PCM) assessments of patient reported outcomes during routine care for up to 2 years from the date of bone metastasis diagnosis.

Results: The overall rate of fracture in the sample was 17.4%. Of the 321 patients enrolled, 160 were treated as of 60 days after diagnosis of bone metastasis, 147 were untreated, and 14 were unclassified. Of the 147 untreated as of 60 days, 82 did eventually receive zoledronic acid. More than half of all patients treated with zoledronic acid delayed the start of treatment by more than 30 days after diagnosis of bone metastasis. Patients who had a fracture showed decreased mobility and increased pain and anxiety at fracture, with recovery taking ~16 months.

Limitations: Key limitations included: convenience sample with information limited to medical record content, low rate of observed fractures possibly due to limited 2-year follow-up, and exclusion of non-zoledronic acid bisphosphonate use.

Conclusions: Whereas the proportion of patients experiencing a fracture was small, the impact of fracture on HRQoL was significant and was more prominently seen to impact specific dimensions of HRQoL.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Body Mass Index
  • Bone Density Conservation Agents / therapeutic use
  • Bone Neoplasms / complications
  • Bone Neoplasms / epidemiology
  • Bone Neoplasms / secondary*
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / pathology*
  • Diphosphonates / therapeutic use
  • Female
  • Fractures, Bone / drug therapy
  • Fractures, Bone / epidemiology
  • Fractures, Bone / etiology
  • Fractures, Bone / psychology*
  • Humans
  • Imidazoles / therapeutic use
  • Incidence
  • Middle Aged
  • Quality of Life*
  • Retrospective Studies
  • Socioeconomic Factors
  • Zoledronic Acid


  • Bone Density Conservation Agents
  • Diphosphonates
  • Imidazoles
  • Zoledronic Acid