Breast cancer-related vertebral fracture risk characterized
medwireNews: Physicians should be aware of the likelihood of pathologic etiology in advanced breast cancer patients who have sustained fractures of the vertebrae, say US researchers.
The team collated information for 5010 women who received endocrine therapy after invasive breast cancer diagnosis between 1996 and 2014 as part of two studies, and were followed up for a median of 6.7 years. At the time of diagnosis, 24–28% of the women were postmenopausal.
Marilyn Kwan (Kaiser Permanente Northern California, Oakland) and co-workers say that confirmed fractures were reported in 6.8% of the women and that pathologic fractures made up 21.2% of the 104 vertebral fractures and 8.7% of the 46 hip fractures, whereas just 0.7% of the 137 wrist fractures and 3.8% of the 78 humerus fractures were related to breast cancer.
Moreover, pathologic vertebral fractures were significantly more common in patients with stage III–IV breast cancer than those with stage I–II disease (41.2 vs 17.2%), as were pathologic hip fractures (25.0 vs 7.1%). There was less discrepancy by disease stage in the rates of pathologic fractures of the wrist (5.3 vs 0.0%) and humerus (2.2 vs 1.4%).
“Overall, these data support clinicopathologic adjudication of high-risk vertebral fractures and differentiation of prevalent vertebral fractures in studies of women with breast cancer,” Kwan et al write in a letter to JAMA Network Open.
They also suggest that assessing nonpathologic fracture risk by different treatment types, such as receipt of aromatase inhibitors or chemotherapy, might help identify women who will benefit from “aggressive” treatment to reduce the risk of osteoporotic fractures.
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