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
Materials and Methods
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.
Table 1: Subject Anthropometrics
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.
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.
Figure 1: Bone Density in Cancer and Non-Cancer Subject Groups
and WHO Normative Value for Distal Radius
Areal density (g/cm-2)
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.
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.
Melton, L.J.; Eddy, D.M.; Johnston, C.C.: Screening for Osteoporosis. Annals of Internal Medicine, 112:516-528, 1990.
Breast Cancer Patients
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
See page 185 Concave Mirrors The image formed by a concave mirror depends on the location of the object (see A, B, C). Flashlights, car headlights, and telescopes, are a few applications of concave mirrors. (c) McGraw Hill Ryerson 2007...
"There is somewhere out there I can go to" "I feel I am in control of my own career…the difference between before and now is huge!" "I have gained a trusting friend whose opinions I value" "Mentoring is not simply...
We report on general packet loss but also report on packet loss associated with the audio Real-time Transport Protocol (RTP) stream and the video RTP stream. ... With Skype for Business, SILK will be the default codec for all 1:1...
We similarly use the molar mass of C 3 H 8. and the enthalpy change per mole calculated in the text previously to calculate the enthalpy change per gram of that substance.(a) Calculate the standard enthalpy change for the combustion...
Convergence Property PR (322 Million Links): 52 iterations PR (161 Million Links): 45 iterations Scaling factor is roughly linear in logn Convergence Property The Web is an expander-like graph Theory of random walk: a random walk on a graph is...
Tahanan Jenis Tanah JENIS TANAH TAHANAN JENIS TANAH (OHM M) TANAH RAWA 30 TANAH LIAT DAN TANAH LADANG 100 PASIR BASAH 200 KERIKIL BASAH 500 PASIR DAN KERIKIL KERING 1,000 TANAH BERBATU 3,000 Pengukuran Tahanan Pentanahan Untuk mengukur tahanan pentanahan...
Sulfides: (chalcophile elements) Pyrite - Pyrrhotite. FeS 2 - Fe 1-x. SRock Forming Minerals. FDegrees of Freedom = Components - Phases + 2. The Mineralogical Phase Rule. In any chemical system at equilibrium, the following relationship holds: F.
'Anyone Can Edit': Understanding the Produser The Mojtaba Saminejad Lecture Dr Axel Bruns Creative Industries Faculty Queensland University of Technology [email protected] The Produser No, it's not a typo…
Ready to download the document? Go ahead and hit continue!