Assessing the prevalence of compromised bone health among overweight and obese African-American breast cancer survivors: a case-control study Journal Article


Authors: Sheean, P; Liang, H.; Schiffer, L; Arroyo, C.; Troy, K.; Stolley, M
Article Title: Assessing the prevalence of compromised bone health among overweight and obese African-American breast cancer survivors: a case-control study
Abstract: PURPOSE: Osteoporosis increases the risk of fracture and is often considered a late effect of breast cancer treatment. We examined the prevalence of compromised bone health in a sample of exclusively African-American (AA) breast cancer survivors since bone mineral density (BMD) varies by race/ethnicity in healthy populations. METHODS: Using a case-control design, AA women in a weight loss intervention previously diagnosed and treated for stages I-IIIa breast cancer were matched 1:1 on age, race, sex, and BMI with non-cancer population controls (n = 101 pairs) from National Health and Nutrition Examination Survey (NHANES). Questionnaires and dual-energy x-ray absorptiometry (DXA) scanning were completed, and participants were categorized as having normal bone density, low bone mass, or osteoporosis using the World Health Organization (WHO) definition for femoral neck T-scores. RESULTS: The majority of these overweight/obese survivors were 6.6 (+/-4.7) years post-diagnosis, had stage II (n = 46) or stage III (n = 16) disease, and treated with chemotherapy (76 %), radiation (72 %), and/or adjuvant hormone therapies (45 %). Mean femoral neck BMD was significantly lower in cases vs. matched non-cancer population controls (0.85 +/- 0.15 vs. 0.91 +/- 0.14 g/cm(2), respectively; p = 0.007). However, the prevalence of low bone mass and osteoporosis was low and did not significantly differ between groups (n = 101 pairs; p = 0.26), even when restricted to those on adjuvant hormone therapies (n = 45 pairs; p = 0.75). Using conditional logistic regression, controlling for dietary factors and education, the odds of developing compromised bone health in AA breast cancer survivors was insignificant (OR 1.5, 95 % CI 0.52, 5.56). CONCLUSIONS: These null case-control findings challenge the clinical assumption that osteoporosis is highly prevalent among all breast cancer survivors, providing foundational evidence to support differences by race/ethnicity and body weight. IMPLICATIONS FOR CANCER SURVIVORS: Routine bone density testing and regular patient-provider dialogue is critical in overweight/obese AA breast cancer survivors to ensure that healthy lifestyle factors (e.g., ideal weight, regular weight-bearing exercises, dietary adequacy of calcium and vitamin D) support optimal skeletal health.
Keywords: vitamin D; Osteoporosis; Breast cancer; NHANES; African-American; Bone health; Survivor
Journal Title: Journal of cancer survivorship : research and practice
Volume: 10
Issue: 1
ISSN: 1932-2267; 1932-2259
Publisher: Unknown  
Journal Place: United States
Date Published: 2016
Start Page: 21
End Page: 30
Language: eng
DOI/URL:
Notes: ID: 8226; LR: 20160112; GR: P30 AG022849/AG/NIA NIH HHS/United States; GR: R01 CA154406/CA/NCI NIH HHS/United States; GR: R25 CA057699/CA/NCI NIH HHS/United States; JID: 101307557; NIHMS676438; OID: NLM: NIHMS676438 [Available on 02/01/17]; OID: NLM: PMC4587994 [Available on 02/01/17]; OTO: NOTNLM; PMCR: 2017/02/01 00:00; 2014/09/23 [received]; 2015/03/16 [accepted]; 2015/03/29 [aheadofprint]; ppublish