Vertebral fractures among breast cancer survivors in China: a cross-sectional study of prevalence and health services gaps

BMC Cancer. 2018 Jan 30;18(1):104. doi: 10.1186/s12885-018-4014-5.

Abstract

Background: Breast cancer survivors are at high risk for fracture due to cancer treatment-induced bone loss, however, data is scarce regarding the scope of this problem from an epidemiologic and health services perspective among Chinese women with breast cancer.

Methods: We designed a cross-sectional study comparing prevalence of vertebral fractures among age- and BMI-matched women from two cohorts. Women in the Breast Cancer Survivors cohort were enrolled from a large cancer hospital in Beijing. Eligibility criteria included age 50-70 years, initiation of treatment for breast cancer at least 5 years prior to enrollment, and no history of metabolic bone disease or bone metastases. Data collected included sociodemographic characteristics; fracture-related risk factors, screening and preventive measures; breast cancer history; and thoracolumbar x-ray. The matched comparator group was selected from participants enrolled in the Peking Vertebral Fracture Study, an independent cohort of healthy community-dwelling postmenopausal women from Beijing.

Results: Two hundred breast cancer survivors were enrolled (mean age 57.5 ± 4.9 years), and compared with 200 matched healthy women. Twenty-two (11%) vertebral fractures were identified among breast cancer survivors compared with 7 (3.5%) vertebral fractures in the comparison group, yielding an adjusted odds ratio for vertebral fracture of 4.16 (95%CI 1.69-10.21, p < 0.01). The majority had early stage (85.3%) and estrogen and/or progesterone receptor positive (84.6%) breast cancer. Approximately half of breast cancer survivors reported taking calcium supplements, 6.1% reported taking vitamin D supplements, and only 27% reported having a bone density scan since being diagnosed with breast cancer.

Conclusions: Despite a four-fold increased odds of prevalent vertebral fracture among Chinese breast cancer survivors in our study, rates of screening for osteoporosis and fracture risk were low reflecting a lack of standardization of care regarding cancer-treatment induced bone loss.

Keywords: Breast cancer; Cancer treatment-induced bone loss; China; Vertebral fracture.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Antineoplastic Agents / adverse effects
  • Bone Density / drug effects
  • Breast Neoplasms / drug therapy
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / physiopathology*
  • Cancer Survivors
  • China
  • Female
  • Fractures, Bone / chemically induced
  • Fractures, Bone / diagnostic imaging
  • Fractures, Bone / epidemiology
  • Fractures, Bone / physiopathology*
  • Humans
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / physiopathology*
  • Middle Aged
  • Osteoporosis / chemically induced
  • Osteoporosis / diagnostic imaging
  • Osteoporosis / epidemiology
  • Osteoporosis / physiopathology*
  • Risk Factors

Substances

  • Antineoplastic Agents