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Fracture risk in women with breast cancer initiating aromatase inhibitor therapy: A registry-based cohort study

Fracture risk in women with breast cancer initiating aromatase inhibitor therapy: A registry-based cohort study
Fracture risk in women with breast cancer initiating aromatase inhibitor therapy: A registry-based cohort study
Background. Aromatase inhibitors (AIs) used in breast cancer induce loss in bone mineral density (BMD) and are reported to increase fracture risk. Materials and Methods. Using a population‐based BMD registry, we identified women aged at least 40 years initiating AIs for breast cancer with at least 12 months of AI exposure (n = 1,775), women with breast cancer not receiving AIs (n = 1,016), and women from the general population (n = 34,205). Fracture outcomes were assessed to March 31, 2017 (mean, 6.2 years for AI users). Results. At baseline, AI users had higher body mass index (BMI), higher BMD, lower osteoporosis prevalence, and fewer prior fractures than women from the general population or women with breast cancer without AI use (all p < .001). After adjusting for all covariates, AI users were not at significantly greater risk for major osteoporotic fractures (hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.93–1.42), hip fracture (HR, 0.90; 95% CI, 0.56–1.43), or any fracture (HR, 1.06; 95% CI, 0.88–1.28) compared with the general population. Conclusion. Higher baseline BMI, BMD, and lower prevalence of prior fracture at baseline may offset the adverse effects of AI exposure. Although confirmatory data from large cohort studies are required, our findings challenge the view that all women with breast cancer initiating AI therapy should be considered at high risk for fractures. Implications for Practice. In a population‐based observational registry that included 1,775 patients initiating long‐term aromatase inhibitor therapy, risk for major osteoporotic fracture, hip fracture, or any fracture was similar to the general population. Higher baseline body mass index, bone mineral density, and lower prevalence of prior fracture at baseline may offset the adverse effects of aromatase inhibitor exposure.
1083-7159
Leslie, William D.
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Morin, Suzanne N.
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Lix, Lisa M.
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Niraula, Saroj
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McCloskey, Eugene V.
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Johansson, Helena
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Harvey, Nicholas
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Kanis, John A.
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Leslie, William D.
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Morin, Suzanne N.
68489af8-f604-4f28-88e0-60add9fde4ae
Lix, Lisa M.
2fb61783-047d-4a4b-a45d-e09ac0763a7b
Niraula, Saroj
06711258-9723-4a9b-bf1d-706e06d44cb2
McCloskey, Eugene V.
2f057a16-3d4e-4597-80c7-6ce47f969c78
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Kanis, John A.
f1621d8d-8afb-4d97-9679-2165d88a344d

Leslie, William D., Morin, Suzanne N., Lix, Lisa M., Niraula, Saroj, McCloskey, Eugene V., Johansson, Helena, Harvey, Nicholas and Kanis, John A. (2019) Fracture risk in women with breast cancer initiating aromatase inhibitor therapy: A registry-based cohort study. The Oncologist. (doi:10.1634/theoncologist.2019-0149).

Record type: Article

Abstract

Background. Aromatase inhibitors (AIs) used in breast cancer induce loss in bone mineral density (BMD) and are reported to increase fracture risk. Materials and Methods. Using a population‐based BMD registry, we identified women aged at least 40 years initiating AIs for breast cancer with at least 12 months of AI exposure (n = 1,775), women with breast cancer not receiving AIs (n = 1,016), and women from the general population (n = 34,205). Fracture outcomes were assessed to March 31, 2017 (mean, 6.2 years for AI users). Results. At baseline, AI users had higher body mass index (BMI), higher BMD, lower osteoporosis prevalence, and fewer prior fractures than women from the general population or women with breast cancer without AI use (all p < .001). After adjusting for all covariates, AI users were not at significantly greater risk for major osteoporotic fractures (hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.93–1.42), hip fracture (HR, 0.90; 95% CI, 0.56–1.43), or any fracture (HR, 1.06; 95% CI, 0.88–1.28) compared with the general population. Conclusion. Higher baseline BMI, BMD, and lower prevalence of prior fracture at baseline may offset the adverse effects of AI exposure. Although confirmatory data from large cohort studies are required, our findings challenge the view that all women with breast cancer initiating AI therapy should be considered at high risk for fractures. Implications for Practice. In a population‐based observational registry that included 1,775 patients initiating long‐term aromatase inhibitor therapy, risk for major osteoporotic fracture, hip fracture, or any fracture was similar to the general population. Higher baseline body mass index, bone mineral density, and lower prevalence of prior fracture at baseline may offset the adverse effects of aromatase inhibitor exposure.

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Accepted/In Press date: 12 June 2019
e-pub ahead of print date: 10 July 2019
Published date: July 2019

Identifiers

Local EPrints ID: 433017
URI: http://eprints.soton.ac.uk/id/eprint/433017
ISSN: 1083-7159
PURE UUID: 77b3212f-a39d-439d-98dc-eec7f52ff1f1
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

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Date deposited: 06 Aug 2019 16:30
Last modified: 26 Nov 2021 05:15

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Contributors

Author: William D. Leslie
Author: Suzanne N. Morin
Author: Lisa M. Lix
Author: Saroj Niraula
Author: Eugene V. McCloskey
Author: Helena Johansson
Author: Nicholas Harvey ORCID iD
Author: John A. Kanis

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