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Assessing the prevalence of compromised bone health among overweight and obese African-American breast cancer survivors: a case–control study

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Abstract

Purpose

Osteoporosis increases the risk of fracture and is often considered a late effect of breast cancer treatment. We examined the prevalence of compromised bone health in a sample of exclusively African-American (AA) breast cancer survivors since bone mineral density (BMD) varies by race/ethnicity in healthy populations.

Methods

Using a case–control design, AA women in a weight loss intervention previously diagnosed and treated for stages I–IIIa breast cancer were matched 1:1 on age, race, sex, and BMI with non-cancer population controls (n = 101 pairs) from National Health and Nutrition Examination Survey (NHANES). Questionnaires and dual-energy x-ray absorptiometry (DXA) scanning were completed, and participants were categorized as having normal bone density, low bone mass, or osteoporosis using the World Health Organization (WHO) definition for femoral neck T-scores.

Results

The majority of these overweight/obese survivors were 6.6 (±4.7) years post-diagnosis, had stage II (n = 46) or stage III (n = 16) disease, and treated with chemotherapy (76 %), radiation (72 %), and/or adjuvant hormone therapies (45 %). Mean femoral neck BMD was significantly lower in cases vs. matched non-cancer population controls (0.85 ± 0.15 vs. 0.91 ± 0.14 g/cm2, respectively; p = 0.007). However, the prevalence of low bone mass and osteoporosis was low and did not significantly differ between groups (n = 101 pairs; p = 0.26), even when restricted to those on adjuvant hormone therapies (n = 45 pairs; p = 0.75). Using conditional logistic regression, controlling for dietary factors and education, the odds of developing compromised bone health in AA breast cancer survivors was insignificant (OR 1.5, 95 % CI 0.52, 5.56).

Conclusions

These null case–control findings challenge the clinical assumption that osteoporosis is highly prevalent among all breast cancer survivors, providing foundational evidence to support differences by race/ethnicity and body weight.

Implications for Cancer Survivors

Routine bone density testing and regular patient–provider dialogue is critical in overweight/obese AA breast cancer survivors to ensure that healthy lifestyle factors (e.g., ideal weight, regular weight-bearing exercises, dietary adequacy of calcium and vitamin D) support optimal skeletal health.

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Abbreviations

AA:

African-American

AIs:

Aromatase inhibitors

BMI:

Body mass index

BMD:

Bone mineral density

DXA:

Dual-energy x-ray absorptiometry

IOM:

Institute of Medicine

IU:

International units

SERMs:

Selective estrogen receptor modulators

SD:

Standard deviation

WHO:

World Health Organization

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Conflict of interests

The authors have no conflict of interests to disclose regarding the conduct and report of this work.

Funding

This study was funded by the National Institute on Aging, Midwest Roybal Center for Health Promotion and Translation (P30AG022849); National Cancer Institute, Moving Forward (R01CA154406); National Cancer Institute, Cancer Education and Career Development Program (R25CA057699).

Author information

Authors and Affiliations

  1. Marcella Niehoff School of Nursing, Health Sciences Campus, Loyola University Chicago, 2160 South First Avenue, Building 105, Room 2852, Maywood, IL, 60153, USA

    Patricia Sheean

  2. Takeda Development Center Americas, Inc., One Takeda Parkway, Deerfield, IL, 60015, USA

    Huifang Liang

  3. Section for Health Promotion Research, Department of Medicine, University of Illinois at Chicago, 1747 West Roosevelt Road, Room 558, MC 275, Chicago, IL, 60608, USA

    Linda Schiffer, Claudia Arroyo & Melinda Stolley

  4. Biomedical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA

    Karen Troy

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  1. Patricia Sheean
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  2. Huifang Liang
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  3. Linda Schiffer
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Correspondence to Patricia Sheean.

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Sheean, P., Liang, H., Schiffer, L. et al. Assessing the prevalence of compromised bone health among overweight and obese African-American breast cancer survivors: a case–control study. J Cancer Surviv 10, 21–30 (2016). https://doi.org/10.1007/s11764-015-0448-9

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  • DOI: https://doi.org/10.1007/s11764-015-0448-9

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