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J Cancer Surviv. 2016 Feb;10(1):21-30. doi: 10.1007/s11764-015-0448-9. Epub 2015 Mar 29.

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

Author information

1
Marcella Niehoff School of Nursing, Health Sciences Campus, Loyola University Chicago, 2160 South First Avenue, Building 105, Room 2852, Maywood, IL, 60153, USA. psheean1@luc.edu.
2
Takeda Development Center Americas, Inc., One Takeda Parkway, Deerfield, IL, 60015, USA. huifang.liang@takeda.com.
3
Section for Health Promotion Research, Department of Medicine, University of Illinois at Chicago, 1747 West Roosevelt Road, Room 558, MC 275, Chicago, IL, 60608, USA. Ischiff@uic.edu.
4
Section for Health Promotion Research, Department of Medicine, University of Illinois at Chicago, 1747 West Roosevelt Road, Room 558, MC 275, Chicago, IL, 60608, USA. carroy5@uic.edu.
5
Biomedical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA. ktroy@wpi.edu.
6
Section for Health Promotion Research, Department of Medicine, University of Illinois at Chicago, 1747 West Roosevelt Road, Room 558, MC 275, Chicago, IL, 60608, USA. mstolley@uic.edu.

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:

African-American; Bone health; Breast cancer; NHANES; Osteoporosis; Survivor; Vitamin D

PMID:
25820976
PMCID:
PMC4587994
DOI:
10.1007/s11764-015-0448-9
[Indexed for MEDLINE]
Free PMC Article

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