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Bone health issues in breast cancer survivors: a Medicare Current Beneficiary Survey (MCBS) study

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Abstract

Purpose

Breast cancer treatments (chemotherapy and hormone therapy) can cause a rapid loss in bone mineral density, leading to osteoporosis and fractures later in life. Fortunately, preventative measures (vitamin D, exercise, etc.) can delay bone loss if employed early enough. This study compares the prevalence of osteoporosis and osteoporosis-related discussions with physicians among female breast cancer survivors and females with no cancer history to determine if breast cancer patients are being correctly advised on their high risk of bone loss.

Methods

The 2003 Medicare Current Beneficiary Survey, a nationally representative sample of 550 women with a breast cancer history and 6,673 women with no cancer history aged ≥65, was used. The first set of dependent variables collected information on bone health (osteoporosis, falls, and fractures). The second set of dependent variables collected information on bone health discussions with their physician. Multivariate logistic regression models were used to evaluate whether breast cancer was independently associated with bone health issues.

Results

After adjustment for confounders, a breast cancer diagnosis was found to be associated with a higher prevalence of an osteoporosis diagnosis over their lifetime (adjusted odds ratio (ORadj) = 1.32, 95 % confidence interval (95 % CI) = 1.08–1.61) and falls in the previous year (ORadj = 1.23, 95 % CI = 1.01–1.51) compared to respondents without a cancer diagnosis. However, breast cancer respondents were not more likely than respondents without a cancer diagnosis to discuss osteoporosis with their physician (ORadj = 1.20, 95 % CI = 0.96–1.50) or be told they are at high risk for osteoporosis (ORadj = 1.41, 95 % CI = 0.95–2.10).

Conclusions

A breast cancer diagnosis was associated with an increased prevalence of osteoporosis and falls. Nevertheless, breast cancer respondents were not more likely to discuss osteoporosis with their physician nor were they more likely to be considered high risk for osteoporosis. Increased dialogue between physician and breast cancer patient pertaining to bone loss is needed.

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References

  1. Jemal A, Siegel R, Xu J, Ward E (2010) Cancer Statistics, 2010. CA Cancer J Clin 60(5):277–300

    Article  PubMed  Google Scholar 

  2. Smigal C, Jemal A, Ward E, Cokkinides V, Smith R, Howe HL, Thun M (2006) Trends in breast cancer by race and ethnicity: update 2006. CA Cancer J Clin 56(3):168–183

    Article  PubMed  Google Scholar 

  3. CDC (2004) Cancer survivorship–United States, 1971–2001. MMWR Morb Mortal Wkly Rep 53(24):526–529

    Google Scholar 

  4. Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM (2005) Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 23(24):5814–5830

    Article  PubMed  Google Scholar 

  5. Chen Z, Maricic M, Pettinger M, Ritenbaugh C, Lopez AM, Barad DH, Gass M, Leboff MS, Bassford TL (2005) Osteoporosis and rate of bone loss among postmenopausal survivors of breast cancer. Cancer 104(7):1520–1530

    Article  PubMed  Google Scholar 

  6. Lindsey AM, Gross G, Twiss J, Waltman N, Ott C, Moore TE (2002) Postmenopausal survivors of breast cancer at risk for osteoporosis: nutritional intake and body size. Cancer Nurs 25(1):50–56

    Article  PubMed  Google Scholar 

  7. Twiss JJ, Waltman N, Ott CD, Gross GJ, Lindsey AM, Moore TE (2001) Bone mineral density in postmenopausal breast cancer survivors. J Am Acad Nurse Pract 13(6):276–284

    Article  PubMed  CAS  Google Scholar 

  8. Eastell R, Adams JE, Coleman RE, Howell A, Hannon RA, Cuzick J, Mackey JR, Beckmann MW, Clack G (2008) Effect of anastrozole on bone mineral density: 5-year results from the anastrozole, tamoxifen, alone or in combination trial 18233230. J Clin Oncol 26(7):1051–1057

    Article  PubMed  CAS  Google Scholar 

  9. Eastell R, Hannon RA, Cuzick J, Dowsett M, Clack G, Adams JE (2006) Effect of an aromatase inhibitor on bmd and bone turnover markers: 2-year results of the Anastrozole, Tamoxifen, Alone or in Combination (ATAC) trial (18233230). J Bone Miner Res 21(8):1215–1223

    Article  PubMed  CAS  Google Scholar 

  10. Hirbe A, Morgan EA, Uluckan O, Weilbaecher K (2006) Skeletal complications of breast cancer therapies. Clin Cancer Res 12(20 Pt 2):6309s–6314s

    Article  PubMed  CAS  Google Scholar 

  11. Pfeilschifter J, Diel IJ (2000) Osteoporosis due to cancer treatment: pathogenesis and management. J Clin Oncol 18(7):1570–1593

    PubMed  CAS  Google Scholar 

  12. Winters-Stone KM, Nail L, Bennett JA, Schwartz A (2009) Bone health and falls: fracture risk in breast cancer survivors with chemotherapy-induced amenorrhea. Oncol Nurs Forum 36(3):315–325

    Article  PubMed  Google Scholar 

  13. Chen Z, Maricic M, Aragaki AK, Mouton C, Arendell L, Lopez AM, Bassford T, Chlebowski RT (2009) Fracture risk increases after diagnosis of breast or other cancers in postmenopausal women: results from the Women's Health Initiative. Osteoporos Int 20(4):527–536

    Article  PubMed  CAS  Google Scholar 

  14. Chen Z, Maricic M, Bassford TL, Pettinger M, Ritenbaugh C, Lopez AM, Barad DH, Gass M, Leboff MS (2005) Fracture risk among breast cancer survivors: results from the Women's Health Initiative Observational Study. Arch Intern Med 165(5):552–558

    Article  PubMed  Google Scholar 

  15. Kanis JA, McCloskey EV, Powles T, Paterson AH, Ashley S, Spector T (1999) A high incidence of vertebral fracture in women with breast cancer. Br J Cancer 79(7–8):1179–1181

    Article  PubMed  CAS  Google Scholar 

  16. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B (2005) Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 293(18):2257–2264

    Article  PubMed  CAS  Google Scholar 

  17. Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A (2007) Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 370(9588):657–666

    Article  PubMed  CAS  Google Scholar 

  18. Hourigan SR, Nitz JC, Brauer SG, O'Neill S, Wong J, Richardson CA (2008) Positive effects of exercise on falls and fracture risk in osteopenic women. Osteoporos Int 19(7):1077–1086

    Article  PubMed  CAS  Google Scholar 

  19. Centers for Medicare & Medicaid Services (2013) Medicare Current Beneficiary Survey: access to care 2003. http://healthindicators.gov/Resources/DataSources/MCBS_69/Profile. Accessed 09 Oct 2013

  20. Crandall C, Petersen L, Ganz PA, Greendale GA (2004) Bone mineral density and adjuvant therapy in breast cancer survivors. Breast Cancer Res Treat 88(3):257–261

    Article  PubMed  CAS  Google Scholar 

  21. Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C (2009) Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int 20(10):1633–1650

    Article  PubMed  CAS  Google Scholar 

  22. Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB (2009) Incidence and mortality of hip fractures in the United States. JAMA 302(14):1573–1579

    Article  PubMed  CAS  Google Scholar 

  23. Magaziner J, Fredman L, Hawkes W, Hebel JR, Zimmerman S, Orwig DL, Wehren L (2003) Changes in functional status attributable to hip fracture: a comparison of hip fracture patients to community-dwelling aged. Am J Epidemiol 157(11):1023–1031

    Article  PubMed  Google Scholar 

  24. Steiner JF, Kramer AM, Eilertsen TB, Kowalsky JC (1997) Development and validation of a clinical prediction rule for prolonged nursing home residence after hip fracture. J Am Geriatr Soc 45(12):1510–1514

    PubMed  CAS  Google Scholar 

  25. Office of Technology Assessment, Congress, United States (1994) Hip fracture outcomes in people age fifty and over. The Office: U.S. G.P.O, Washington, D.C

    Google Scholar 

  26. Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M, Felsenthal G, Kenzora J (2000) Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 55(9):M498–507

    Article  PubMed  CAS  Google Scholar 

  27. Papaioannou A, Watts NB, Kendler DL, Yuen CK, Adachi JD, Ferko N (2002) Diagnosis and management of vertebral fractures in elderly adults. Am J Med 113(3):220–228

    Article  PubMed  Google Scholar 

  28. Tosteson AN, Hammond CS (2002) Quality-of-life assessment in osteoporosis: health-status and preference-based measures. Pharmacoeconomics 20(5):289–303

    Article  PubMed  Google Scholar 

  29. Brufsky AM (2008) Cancer treatment-induced bone loss: pathophysiology and clinical perspectives. Oncologist 13(2):187–195

    Article  PubMed  CAS  Google Scholar 

  30. Bischoff-Ferrari HA, Willett WC, Wong JB, Stuck AE, Staehelin HB, Orav EJ, Thoma A, Kiel DP, Henschkowski J (2009) Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med 169(6):551–561

    Article  PubMed  CAS  Google Scholar 

  31. Peppone LJ, Mustian KM, Janelsins MC, Palesh OG, Rosier RN, Piazza KM, Purnell JQ, Darling TV, Morrow GR (2010) Effects of a structured weight-bearing exercise program on bone metabolism among breast cancer survivors: a feasibility trial. Clin Breast Cancer 10(3):224–229

    Article  PubMed  Google Scholar 

  32. Mincey BA, Duh MS, Thomas SK, Moyneur E, Marynchencko M, Boyce SP, Mallett D, Perez EA (2006) Risk of cancer treatment-associated bone loss and fractures among women with breast cancer receiving aromatase inhibitors. Clin Breast Cancer 7(2):127–132

    Article  PubMed  CAS  Google Scholar 

  33. Saad F, Adachi JD, Brown JP, Canning LA, Gelmon KA, Josse RG, Pritchard KI (2008) Cancer treatment-induced bone loss in breast and prostate cancer. J Clin Oncol 26(33):5465–5476

    Article  PubMed  Google Scholar 

  34. Cadarette SM, Beaton DE, Gignac MA, Jaglal SB, Dickson L, Hawker GA (2007) Minimal error in self-report of having had DXA, but self-report of its results was poor. J Clin Epidemiol 60(12):1306–1311

    Article  PubMed  Google Scholar 

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Acknowledgments

This study is supported by grant 1K07CA168911-01A1 from the National Cancer Institute and grant MRSG-13-001-01-CCE from the American Cancer Society. We are grateful to Dr. Susan Rosenthal for her excellent editorial assistance.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, University of Rochester, 601 Elmwood Ave., Box 704, Rochester, NY, 14642, USA

    Luke J. Peppone, Karen M. Mustian, Michelle C. Janelsins & Gary R. Morrow

  2. Department of Orthopaedics, University of Rochester, Rochester, NY, USA

    Randy N. Rosier

  3. Department of Family Medicine, University of Rochester, Rochester, NY, USA

    Jennifer K. Carroll

  4. Brown School of Social Work, Washington University, St Louis, MO, USA

    Jason Q. Purnell

  5. Department of Medicine, University of Rochester, Rochester, NY, USA

    Supriya G. Mohile

Authors
  1. Luke J. Peppone
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  4. Jennifer K. Carroll
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Correspondence to Luke J. Peppone.

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Peppone, L.J., Mustian, K.M., Rosier, R.N. et al. Bone health issues in breast cancer survivors: a Medicare Current Beneficiary Survey (MCBS) study. Support Care Cancer 22, 245–251 (2014). https://doi.org/10.1007/s00520-013-1967-4

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  • DOI: https://doi.org/10.1007/s00520-013-1967-4

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