Osteoporosis International

, Volume 15, Issue 7, pp 535–540 | Cite as

Radial bone density and breast cancer risk in white and African-American women

  • D. A. Nelson
  • L. L. Darga
  • M. S. Simon
  • R. K. Severson
Original Article


A number of different models for assessing individual risk of breast cancer use known risk factors such as age, age at menarche, age at first live birth, previous breast biopsies, and family history. High bone mass in white women is also associated with an increased breast cancer risk; however, bone mass as a risk factor has not been studied in African-American women. We conducted a case-control study to evaluate bone mineral density as a risk factor for breast cancer in white and African-American women. We recruited 221 women with newly diagnosed breast cancer from a comprehensive breast cancer center at a large university hospital, and 197 control women who were frequency matched for ethnicity and age. Odds ratios were based on proximal and distal radial bone density measured by peripheral bone densitometry (Norland pDEXA) and expressed as a standardized “Z-score” (age and ethnicity specific). Logistic regression models were fitted controlling for body mass index, menopausal status, age, and HRT use (ever/never and duration). With proximal bone density Z-score included in the model as a continuous variable, a one-unit increase in radial shaft bone density increased the risk of breast cancer by 25% (p=0.02). When proximal bone density Z-score was analyzed as a dichotomous variable (≤0, >0) the odds ratio was 1.98 (95% CI, 1.32 to 2.97); that is, having an above average proximal bone density (age-specific) doubles the risk of breast cancer. There were no significant interactions with, and no appreciable confounding effects by, other covariates. An above-average radial shaft Z-score is a significant risk factor for breast cancer in both white and African-American women. The present study extends the association between bone mass and breast cancer risk to African-Americans, and suggests another potential application for bone density testing.


Bone density Breast cancer risk Ethnicity 


  1. 1.
    Rhodes DJ (2002) Identifying and counseling women at increased risk for breast cancer. Mayo Clin Proc 77:355–360PubMedGoogle Scholar
  2. 2.
    Eehus DM (2001) Understanding mathematical models for breast cancer risk assessment and counseling. Breast J 7:224–232PubMedGoogle Scholar
  3. 3.
    Gail MH, Brinton LA, Byar DP, Corle DK, Green SB, Schairer C, Mulvihill JJ (1989) Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst 81:1879–1886CrossRefPubMedGoogle Scholar
  4. 4.
    Zmuda JM, Cauley JA, Ljung B-M, Bauer DC, Cummings SR, Kuller LH, for the Study of Osteoporotic Fractures Research Group (2001) Bone mass and breast cancer risk in older women: differences by stage at diagnosis. J Natl Cancer Inst 93:930–936CrossRefPubMedGoogle Scholar
  5. 5.
    Zhang Y, Kiel DP, Kreger BE, Cupples LA, Ellison RC, Dorgan JF, Schatzkin A, Levy D, Felson DT (1997) Bone mass and the risk of breast cancer among postmenopausal women. N Engl J Med 336:611–617CrossRefPubMedGoogle Scholar
  6. 6.
    Buist DSM, LaCroix AZ, Barlow WE, White E, Weiss NS (2001) Bone mineral density and breast cancer risk in postmenopausal women. J Clin Epidemiol 54:417–422CrossRefPubMedGoogle Scholar
  7. 7.
    van der Klift M, Laet CE, Coebergh JW, Hofman A, Pols HA (2003) Bone mineral density and the risk of breast cancer: the Rotterdam Study. Bone 32:211–6CrossRefPubMedGoogle Scholar
  8. 8.
    Nguyen TV, Center JR, Eisman JA (2000) Association between breast cancer and bone mineral density: the Dubbo Osteoporosis Epidemiology Study. Maturitas 36:27–34CrossRefPubMedGoogle Scholar
  9. 9.
    Black DM, Reiss TF, Nevitt Mc, Cauley J, Karpf D, Cummings SR (1993) Design of the Fracture Intervention Trial. Osteoporos Int 3[Suppl 3]:S29–S39Google Scholar
  10. 10.
    Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor E, Musliner TA, Palermo L, Prineas R, Rubin SM, Scott JC, Vogt T, Wallace R, Yates AJ, LaCroix AZ (1998) Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 280:2077–2082PubMedGoogle Scholar
  11. 11.
    Simon MS, Severson RK (1996) Racial differences in survival of female breast cancer in the Detroit metropolitan area. Cancer 77:308–314CrossRefPubMedGoogle Scholar
  12. 12.
    Bradley CJ, Given CW, Roberts C (2002) Race, socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst 94:490–496CrossRefPubMedGoogle Scholar
  13. 13.
    Kleerekoper M, Nelson DA, Peterson EL, Flynn MJ, Pawluszka AS, Jacobsen G, Wilson P (1994) Reference data for bone mass, calciotropic hormones and biochemical markers of bone remodeling in older (55–75), postmenopausal white and black women. J Bone Miner Res 9:1267–1276PubMedGoogle Scholar
  14. 14.
    Meier DE, Luckey MM, Wallenstein S, Clemens TL, Orwoll ES, Waslien CI (1991) Calcium, vitamin D, and parathyroid hormone status in young white and black women: association with racial differences in bone mass. J Clin Endocrinol Metab 72:703–710PubMedGoogle Scholar
  15. 15.
    Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC Jr, Lindsay RL (1995) Proximal femur bone mineral levels of US adults. Osteoporos Int 5:389–409PubMedGoogle Scholar
  16. 16.
    Blake GM, Fogelman I (1997) Technical principles of dual energy x-ray absorptiometry. Semin Nucl Med 27:210–228PubMedGoogle Scholar
  17. 17.
    Miller PD, Siris ES, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Chen YT, Berger ML, Santora AC, Sherwood LM (2002) Prediction of fracture risk in postmenopausal white women with peripheral bone densitometry: evidence from the National Osteoporosis Risk Assessment. J Bone Miner Res 17:2222–2230PubMedGoogle Scholar
  18. 18.
    Hagiwara S, Engelke K, Yang SO, Dhillon MS, Guglielmi G, Nelson DL, Genant HK (1994) Dual x-ray absorptiometry forearm software: accuracy and intermachine relationship. J Bone Miner Res 9:1425–1427PubMedGoogle Scholar
  19. 19.
    Nelson D, Feingold M, Mascha E, Kleerekoper M (1992) Comparison of single-photon and dual-energy x-ray absorptiometry of the radius. Bone Miner 18:77–83PubMedGoogle Scholar
  20. 20.
    Nieves JW, Cosman F, Mars C, Lindsay R (1992) Comparative assessment of bone mineral density of the forearm using single photon an dual X-ray absorptiometry. Calcif Tissue Int 51:352–355PubMedGoogle Scholar
  21. 21.
    Leboff MS, Fuleihan GE, Angell JE, Chung S, Curtis K (1992) Dual-energy x-ray absorptiometry of the forearm: reproducibility and correlation with single-photon absorptiometry. J Bone Miner Res 7:841–846PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2004

Authors and Affiliations

  • D. A. Nelson
    • 1
    • 3
    • 4
  • L. L. Darga
    • 1
    • 3
  • M. S. Simon
    • 1
    • 3
  • R. K. Severson
    • 2
    • 3
  1. 1.Department of Internal MedicineWayne State UniversityDetroitUSA
  2. 2.Department of Family MedicineWayne State UniversityDetroitUSA
  3. 3.Karmanos Cancer InstituteDetroitUSA
  4. 4.Rheumatology, UHC 4-HWayne State UniversityDetroitUSA

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