Transcript Radial Bone Mineral Density in Caucasian Breast

Radial Bone Mineral Density in Caucasian Breast Cancer Patients
#
*
Laura M. Gehrig,
 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
#
MD
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 (58.9±11.7 years; 163.0±5.3 cm; 78.5±25.7 kg) with either uni- or
bilateral lumpectomy or mastectomy were compared to 23 Caucasian females
without breast cancer (48.8±13.7 years; 162.9±6.6 cm; 74.1±19.7 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-score–0.9.
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
(58.9±11.7 years; 163.0±5.3 cm; 78.5±25.7 kg)
were compared to twenty-three Caucasian
females without history of breast cancer
(48.8±13.7 years; 162.9±6.6 cm; 74.1±19.7 kg).
Areal BMD (g/cm²) 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 was–1.5. 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.
Conclusion
Data Analyses
Table 1: Subject Anthropometrics
Non-CA Patients
Age (yrs)
58.86±11.71
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
References
Figure 1: Bone Density in Cancer and Non-Cancer Subject Groups
and WHO Normative Value for Distal Radius
0.500
Areal density (g/cm-2)
CA Patients
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.
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