Fracture risk in older, long-term survivors of early-stage breast cancer

J Am Geriatr Soc. 2013 Jun;61(6):888-895. doi: 10.1111/jgs.12269. Epub 2013 May 6.


Objectives: To examine the effect of breast cancer and its treatment on fracture risk in older breast cancer survivors.

Design: A 10-year prospective cohort study beginning 5 years after a diagnosis of breast cancer for survivors and match date for comparison women.

Setting: Six integrated healthcare systems.

Participants: Women aged 65 and older (1,286 survivors, 1,286 comparison women, mean age 77.7 in both groups, white, non-Hispanic: survivors, 81.6%; comparison women, 85.2%) who were alive and recurrence free 5 years after a diagnosis of early-stage breast cancer and matched on age, study site, and enrollment year to a comparison cohort without breast cancer.

Measurements: Cox proportional hazards models were used to estimate the association between fracture risk and survivor-comparison status, adjusting for drugs and risk factors associated with bone health. A subanalysis was used to evaluate the association between tamoxifen exposure and fracture risk.

Results: No difference was observed in fracture rates between groups (hazard ratio (HR) = 1.1, 95% confidence interval (CI) = 0.9-1.3). The protective effect of tamoxifen was not statistically significant (HR = 0.9, 95% CI = 0.6-1.2).

Conclusion: Long-term survivors of early-stage breast cancer diagnosed at age 65 and older are not at greater risk of osteoporotic fractures than age-matched women without breast cancer. There appears to be no long-term protection from fractures with tamoxifen use.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / complications*
  • Breast Neoplasms / mortality
  • Breast Neoplasms / pathology
  • Disease-Free Survival
  • Early Detection of Cancer*
  • Female
  • Follow-Up Studies
  • Fractures, Bone / epidemiology*
  • Fractures, Bone / etiology
  • Humans
  • Incidence
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm Staging*
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Survival Rate / trends
  • Survivors
  • Time Factors
  • United States / epidemiology