Fracture risk and adjuvant hormonal therapy among a population-based cohort of older female breast cancer patients
Identifieur interne : 004031 ( Ncbi/Merge ); précédent : 004030; suivant : 004032Fracture risk and adjuvant hormonal therapy among a population-based cohort of older female breast cancer patients
Auteurs : J. M. Neuner ; T. W. Yen ; R. A. Sparapani ; P. W. Laud ; A. B. NattingerSource :
- Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA [ 0937-941X ] ; 2010.
Abstract
The risk of hip and other fractures was examined among a population-based group of older women with breast cancer. Women using aromatase inhibitors (AIs) were found to be over three times more likely to have a hip fracture over approximately 3 years’ follow-up. Other fracture risk factors were also identified.
Aromatase inhibitors have been shown in randomized trials to increase total fracture risk compared with tamoxifen, but the fracture risks in the trials were relatively low, and no difference in hip fracture has been demonstrated.
A population-based cohort of 2003 breast cancer survivors ≥65 were followed prospectively for a median of 36 months. Patient survey information regarding adjuvant breast cancer therapies, prescription osteoporosis treatments, and other factors potentially associated with fracture was supplemented with cancer registry information. Hip and total nonvertebral fractures were determined using a validated Medicare algorithm, and the association of these fractures with adjuvant hormonal therapies was examined using Cox models.
The cohort of 2,748 women with a mean age of 72.8 (SD 5.4) included 28.2% who took an aromatase inhibitor and 27.8% tamoxifen. There were 41 hip fractures (1.5%) and 218 nonvertebral fractures (7.9%) among the cohort. Subjects using AIs (adjusted hazard ratio 3.24 (1.05, 9.98)) and subjects not using hormone therapy (3.32 (1.14, 9.65)) were more likely than users of tamoxifen to have a hip fracture. Bisphosphonate use was more common among AI users but did not explain these results. Users of AIs were more likely to have nonvertebral fractures, but this result did not reach statistical significance (adjusted hazard 1.34 (0.92, 1.94)).
Hip and other fractures were common in an older population-based cohort of breast cancer survivors, and aromatase inhibitor use was associated with an increase in the short-term risk of hip fractures not detected in randomized controlled trials
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DOI: 10.1007/s00198-010-1493-x
PubMed: 21170643
PubMed Central: 3166362
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M." last="Neuner">J. M. Neuner</name></author><author><name sortKey="Yen, T W" sort="Yen, T W" uniqKey="Yen T" first="T. W." last="Yen">T. W. Yen</name></author><author><name sortKey="Sparapani, R A" sort="Sparapani, R A" uniqKey="Sparapani R" first="R. A." last="Sparapani">R. A. Sparapani</name></author><author><name sortKey="Laud, P W" sort="Laud, P W" uniqKey="Laud P" first="P. W." last="Laud">P. W. Laud</name></author><author><name sortKey="Nattinger, A B" sort="Nattinger, A B" uniqKey="Nattinger A" first="A. B." last="Nattinger">A. B. Nattinger</name></author></analytic><series><title level="j">Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA</title><idno type="ISSN">0937-941X</idno><idno type="eISSN">1433-2965</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Summary</title><p id="P1">The risk of hip and other fractures was examined among a population-based group of older women with breast cancer. Women using aromatase inhibitors (AIs) were found to be over three times more likely to have a hip fracture over approximately 3 years’ follow-up. Other fracture risk factors were also identified.</p></sec><sec id="S2"><title>Introduction</title><p id="P2">Aromatase inhibitors have been shown in randomized trials to increase total fracture risk compared with tamoxifen, but the fracture risks in the trials were relatively low, and no difference in hip fracture has been demonstrated.</p></sec><sec sec-type="methods" id="S3"><title>Methods</title><p id="P3">A population-based cohort of 2003 breast cancer survivors ≥65 were followed prospectively for a median of 36 months. Patient survey information regarding adjuvant breast cancer therapies, prescription osteoporosis treatments, and other factors potentially associated with fracture was supplemented with cancer registry information. Hip and total nonvertebral fractures were determined using a validated Medicare algorithm, and the association of these fractures with adjuvant hormonal therapies was examined using Cox models.</p></sec><sec id="S4"><title>Results</title><p id="P4">The cohort of 2,748 women with a mean age of 72.8 (SD 5.4) included 28.2% who took an aromatase inhibitor and 27.8% tamoxifen. There were 41 hip fractures (1.5%) and 218 nonvertebral fractures (7.9%) among the cohort. Subjects using AIs (adjusted hazard ratio 3.24 (1.05, 9.98)) and subjects not using hormone therapy (3.32 (1.14, 9.65)) were more likely than users of tamoxifen to have a hip fracture. Bisphosphonate use was more common among AI users but did not explain these results. Users of AIs were more likely to have nonvertebral fractures, but this result did not reach statistical significance (adjusted hazard 1.34 (0.92, 1.94)).</p></sec><sec id="S5"><title>Conclusions</title><p id="P5">Hip and other fractures were common in an older population-based cohort of breast cancer survivors, and aromatase inhibitor use was associated with an increase in the short-term risk of hip fractures not detected in randomized controlled trials</p></sec></div></front></TEI><pmc article-type="research-article" xml:lang="EN"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">9100105</journal-id><journal-id journal-id-type="pubmed-jr-id">2061</journal-id><journal-id journal-id-type="nlm-ta">Osteoporos Int</journal-id><journal-title>Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA</journal-title><issn pub-type="ppub">0937-941X</issn><issn pub-type="epub">1433-2965</issn></journal-meta><article-meta><article-id pub-id-type="pmid">21170643</article-id><article-id pub-id-type="pmc">3166362</article-id><article-id pub-id-type="doi">10.1007/s00198-010-1493-x</article-id><article-id pub-id-type="manuscript">NIHMS265262</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Fracture risk and adjuvant hormonal therapy among a population-based cohort of older female breast cancer patients</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Neuner</surname><given-names>J. M.</given-names></name><email>jneuner@mcw.edu</email><aff id="A1">Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA</aff><aff id="A2">Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA</aff></contrib><contrib contrib-type="author"><name><surname>Yen</surname><given-names>T. W.</given-names></name><aff id="A3">Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA</aff><aff id="A4">Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA</aff></contrib><contrib contrib-type="author"><name><surname>Sparapani</surname><given-names>R. A.</given-names></name><aff id="A5">Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA</aff></contrib><contrib contrib-type="author"><name><surname>Laud</surname><given-names>P. W.</given-names></name><aff id="A6">Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA</aff><aff id="A7">Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA</aff></contrib><contrib contrib-type="author"><name><surname>Nattinger</surname><given-names>A. B.</given-names></name><aff id="A8">Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA</aff><aff id="A9">Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA</aff></contrib></contrib-group><pub-date pub-type="nihms-submitted"><day>15</day><month>2</month><year>2011</year></pub-date><pub-date pub-type="epub"><day>18</day><month>12</month><year>2010</year></pub-date><pub-date pub-type="ppub"><month>11</month><year>2011</year></pub-date><pub-date pub-type="pmc-release"><day>1</day><month>11</month><year>2012</year></pub-date><volume>22</volume><issue>11</issue><fpage>2847</fpage><lpage>2855</lpage><permissions><copyright-statement>© International Osteoporosis Foundation and National Osteoporosis Foundation 2010</copyright-statement><copyright-year>2010</copyright-year></permissions><abstract><sec id="S1"><title>Summary</title><p id="P1">The risk of hip and other fractures was examined among a population-based group of older women with breast cancer. Women using aromatase inhibitors (AIs) were found to be over three times more likely to have a hip fracture over approximately 3 years’ follow-up. Other fracture risk factors were also identified.</p></sec><sec id="S2"><title>Introduction</title><p id="P2">Aromatase inhibitors have been shown in randomized trials to increase total fracture risk compared with tamoxifen, but the fracture risks in the trials were relatively low, and no difference in hip fracture has been demonstrated.</p></sec><sec sec-type="methods" id="S3"><title>Methods</title><p id="P3">A population-based cohort of 2003 breast cancer survivors ≥65 were followed prospectively for a median of 36 months. Patient survey information regarding adjuvant breast cancer therapies, prescription osteoporosis treatments, and other factors potentially associated with fracture was supplemented with cancer registry information. Hip and total nonvertebral fractures were determined using a validated Medicare algorithm, and the association of these fractures with adjuvant hormonal therapies was examined using Cox models.</p></sec><sec id="S4"><title>Results</title><p id="P4">The cohort of 2,748 women with a mean age of 72.8 (SD 5.4) included 28.2% who took an aromatase inhibitor and 27.8% tamoxifen. There were 41 hip fractures (1.5%) and 218 nonvertebral fractures (7.9%) among the cohort. Subjects using AIs (adjusted hazard ratio 3.24 (1.05, 9.98)) and subjects not using hormone therapy (3.32 (1.14, 9.65)) were more likely than users of tamoxifen to have a hip fracture. Bisphosphonate use was more common among AI users but did not explain these results. Users of AIs were more likely to have nonvertebral fractures, but this result did not reach statistical significance (adjusted hazard 1.34 (0.92, 1.94)).</p></sec><sec id="S5"><title>Conclusions</title><p id="P5">Hip and other fractures were common in an older population-based cohort of breast cancer survivors, and aromatase inhibitor use was associated with an increase in the short-term risk of hip fractures not detected in randomized controlled trials</p></sec></abstract><kwd-group><kwd>Breast cancer</kwd><kwd>Hip fracture</kwd><kwd>Medication-associated osteoporosis</kwd></kwd-group></article-meta></front></pmc><affiliations><list></list><tree><noCountry><name sortKey="Laud, P W" sort="Laud, P W" uniqKey="Laud P" first="P. W." last="Laud">P. W. Laud</name><name sortKey="Nattinger, A B" sort="Nattinger, A B" uniqKey="Nattinger A" first="A. B." last="Nattinger">A. B. Nattinger</name><name sortKey="Neuner, J M" sort="Neuner, J M" uniqKey="Neuner J" first="J. M." last="Neuner">J. M. Neuner</name><name sortKey="Sparapani, R A" sort="Sparapani, R A" uniqKey="Sparapani R" first="R. A." last="Sparapani">R. A. Sparapani</name><name sortKey="Yen, T W" sort="Yen, T W" uniqKey="Yen T" first="T. W." last="Yen">T. W. Yen</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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