Radial Bone Mineral Density in Caucasian Breast Cancer

Radial Bone Mineral Density in Caucasian Breast Cancer

Radial Bone Mineral Density in Caucasian Breast Cancer Patients
Laura M. Gehrig, MD# James W. Bellew, EdD, PT *# Gary V. Burton**
#
Osteoporosis Center *Program in Physical Therapy **Feist-Weiller Cancer Center
Louisiana State University Health Sciences Center Shreveport, LA 71130

Abstract

Materials and Methods

Discussion

Purpose: To compare radial bone mineral densities in female patients with
breast cancer to non-breast cancer patients. Methods: Seventy Caucasian
females (58.911.7 years; 163.05.3 cm; 78.525.7 kg) with either uni- or
bilateral lumpectomy or mastectomy were compared to 23 Caucasian females
without breast cancer (48.813.7 years; 162.96.6 cm; 74.119.7 kg).
Peripheral densitometry was used to determine T-scores and areal densities
(g/cm-2) of the distal radius in the right upper extremity of each subject. Raw
density was compared between groups using an independent samples t-test
while one sample t-tests were used to compare each group to normative values
from the World Health Organization (WHO) for the distal radius of adult
women. Results: The mean density of the patient group was 0.400.066 with a
mean T-score of 1.5. The mean density of the non-patient group was
0.433.060 with a T-score0.9. Raw density in patients with cancer was
significantly less than the non-patient group (p=0.035) and WHO normative
values (p<.001). Conclusion: Distal radial density of adult Caucasian female patients with breast cancer is significantly less than Caucasian females without breast cancer and less than normative values issued by the World Health Organization. These differences are reflected in the T-scores which demonstrate greater increase in fracture risk in Caucasian female breast cancer patients. Cohort with breast cancer, metabolic pathology resulting in demineralization and loss of the micro-architectural stability of bone must be addressed in patients with breast cancer. Seventy Caucasian female patients with either unilateral or bilateral lumpectomy or mastectomy (58.911.7 years; 163.05.3 cm; 78.525.7 kg) were compared to twenty-three Caucasian females without history of breast cancer (48.813.7 years; 162.96.6 cm; 74.119.7 kg). Areal BMD (g/cm) of the right distal radius was measured in a single session using the Lunar PIXI densitometer. The validity of the PIXI has been calculated at r=0.990 (SEE=0.015 g/cm2).3 Prior to our data collection, the densitometer was calibrated using known densities (Lunar phantoms) to an accuracy of greater than 99% and reliability testing on 20 young adult females in our lab yielded an intraclass correlation coefficient (ICC) of 0.98. Based on peripheral bone density testing, the mean T-score of the patient group with breast cancer was1.5. As defined by the World health Organization, this would mean that this population as a whole had osteopenia. Raw density in patients with cancer was significantly less than the non-patient group (p=0.035) and WHO normative values (p<.001). For those patients who have breast cancer, a program that incorporates peripheral bone mineral density testing early in the course of the disease to identify bone loss and increased fracture risk, and then surveillance over time assures early intervention and continued care to protect against future fracture. Functional rehabilitation and activity appears promising in helping to control bone loss in breast cancer patients in addition to approved drugs and preventative measures. Bone protection is important to assure that low energy fractures do not occur. The end result is longer functional use of the upper extremity with resultant increased quality of life. Data Analyses Table 1: Subject Anthropometrics Non-CA Patients Age (yrs) 58.8611.71 48.78 13.67 Height (cm) 163.04 5.01 162.89 6.59 Introduction Weight (kg) 78.50 25.72 74.08 19.68 Breast cancer is a debilitating disease. Each year approximately 200,000 women and 1,500 men will learn they have breast cancer. Treatments for breast cancer may include surgery, chemotherapy and radiation, or a combination of them. Associated with breast cancer and treatment is bone loss, and musculoskeletal complications. These complications include post-mastectomy pain and lymphedema, disuse of the upper extremities due to surgery and consequent osteopenia and osteoporosis. Adjuvant chemotherapy in pre-menopausal women often results in premature menopause (25% in patients less than 40 years old) and could contribute to accelerated bone loss. Quantitating an increased risk of bone loss in this population would suggest that early identification and an intervention program could help decrease bone loss and decrease future fracture risk. Strength training, resistance training, nutritional supplementation, tailored physical therapy and formal safety instruction could be implemented early. Starting an early program at the outset of detection would help provide protection against further bone loss and provide some bone protection. BMI (kg/m2) 29.52 9.54 27.93 7.39 BMD (g/cm2) .400 .07 .433 .06 Means and standard deviations were calculated by conventional methods using SPSS (v12.0 for Windows). Raw density was compared between the groups using an independent samples t-test while one sample t-tests were used to compare each group to normative values from the World Health Organization (WHO) for the distal radius of adult women. Conclusion: Distal radial density of adult Caucasian female patients with breast cancer as demonstrated in this population is significantly less than Caucasian females without breast cancer and less than normative values issued by the World Health Organization. These differences are reflected in the T-scores which demonstrate greater increase in fracture risk in Caucasian female breast cancer patients. Cohort with breast cancer, metabolic pathology resulting in demineralization and loss of the micro-architectural stability of bone must be considered and addressed early in patients with breast cancer. References Figure 1: Bone Density in Cancer and Non-Cancer Subject Groups and WHO Normative Value for Distal Radius 0.500 0.489 0.450 Areal density (g/cm-2) CA Patients Conclusion 0.400 0.350 0.400 0.433 Sandler, R.B.; Cauley, J.A.; Hom, D.L.; Sashin, D.; and Kriska, A.M.: The Effects of Walking on the Cross-Sectional Dimension of the Radius in Postmenopausal Women. Calcif. Tissue Int. 41:65-69, 1987. Who are the candidates for prevention and treatment of osteoporosis? Osteoporosis Int. 7:1-6, 1997. Love, R.R.; Richard, B. ; Mazess, D. ; Howard, S.B. ; Barden, H.S. ; Epstein, S. et al. 1992. Effects of Tamoxifen on Bone Mineral Density in Postmenopausal Women with Breast Cancer. New Engl. J. Med. 326(13):852-6, March 1992. Tsuji, S. ; Tsunoda, N. ; Yata, H. ; Katsukawa, F. ; Onishi, S. ; Yamazaki, H.: Relation Between Grip Strength and Radial Bone Mineral Density in Young Athletes. Arch Phys Med Rehabil. 76:234-237, March 1995. 0.300 0.250 Duboeuf, F.; Sornay-Rendu, E.; Garnero, P.; Bourgeaud-Lignot, A.; Delmas, P.D.: Cross-Sectional and Longitudinal Assessment of Pre- and Postmenopausal Bone Loss with a Portable Forearm X-Ray Device: The Ofely Study. Bone, 26(2): 131-135, Feb 2000. 0.200 0.150 0.100 Melton, L.J.; Eddy, D.M.; Johnston, C.C.: Screening for Osteoporosis. Annals of Internal Medicine, 112:516-528, 1990. 0.050 0.000 Breast Cancer Patients Controls Subject Group WHO norms Hawker, G.A; Forsmo, S.; Cadarette, S.M., Schei, B.; Jaglal, S.B.; Forsen, L.; Langhammer, A: Correlates of Forearm Bone Mineral Density in Young Norwegian Women: The Nord-Trondelag Health Study. Am J Epidemiol, 156(5):418-27, Sept 1 2002.

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