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Bone loss in the affected forearm in patients with breast cancer-related lymphedema: a controlled study

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Abstract

Purpose

We aimed to investigate the association between lymphedema and bone mass density (BMD) of affected and unaffected forearms in patients with breast cancer-related lymphedema (BCRL). We also explored whether there was a relationship between any disability and BMD on the affected side.

Methods

We evaluated 111 patients (53.75 ± 9.07) with unilateral lymphedema (group 1) and 61 patients (50.90 ± 12.44) without lymphedema (group 2) after breast cancer surgery. BMD was performed by dual-energy x-ray absorptiometry (DXA) in lumbar spine, femoral neck, and distal forearm on both sides. Functional situation was assessed by the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire.

Results

The total Z score (p = 0.018), T score (p = 0.005), and BMD value (p = 0.014) were lower in the affected forearm than the unaffected forearm in group 1. There was no difference between the affected or unaffected sides in the total Z score (p = 0.394), T score (p = 0.518), and BMD value (p = 0.629) in group 2. The DXA measurements in terms of the total forearm Z, T scores, and BMD value on the affected side were statistically significantly different between the groups. There was no difference between groups in the femur neck and lumbar total Z and T scores. There was also a positive correlation between the QuickDASH scores and lymphedema stage (r = 0.469, p = 0.001) and the duration without treatment of lymphedema (r = 0.298, p = 0.02) in group 1.

Conclusion

We recommend early diagnosis and treatment of lymphedema for the protection of upper extremity disability and localized osteoporosis in patients with BCRL.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Division of Oncological Rehabilitation, S.B.U Ankara Training and Research Hospital, Ankara, Turkey

    Secil Pervane Vural, F. Figen Ayhan & Burcu Duyur Cakit

  2. Division of Surgical Oncology, Department of Surgery, Magee-Womens Hospital of University of Pittsburgh Medical Center, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Atilla Soran

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  1. Secil Pervane Vural
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  2. F. Figen Ayhan
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Correspondence to Secil Pervane Vural.

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The authors declare that they have no conflict of interest.

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Pervane Vural, S., Ayhan, F.F., Duyur Cakit, B. et al. Bone loss in the affected forearm in patients with breast cancer-related lymphedema: a controlled study. Support Care Cancer 27, 2545–2551 (2019). https://doi.org/10.1007/s00520-018-4541-2

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  • DOI: https://doi.org/10.1007/s00520-018-4541-2

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