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Osteoporosis, an indicator of significant bone loss, has been consistently reported among older breast cancer survivors. Data are limited on the incidence of osteopenia, an earlier indicator of bone loss, and osteoporosis in younger breast cancer survivors compared with cancer-free women.
Younger breast cancer survivors are at higher risk for osteopenia and osteoporosis compared to cancer-free women. Studies are needed to determine effective approaches to minimize bone loss in this population.
Osteopenia and osteoporosis, both systemic skeletal conditions associated with varying degrees of bone loss, are prevalent among postmenopausal breast cancer survivors, with prior reports of up to 80% experiencing loss in bone density . Untreated bone loss can lead to significant morbidity due to pain and fractures, as well as to death . Osteopenia is diagnosed among individuals with lower-than-average bone density, while osteoporosis is characterized by both low bone density and architectural deterioration of bone tissue . Among breast cancer survivors, cancer-related risk factors for osteopenia and osteoporosis include both treatment and premature menopause . Importantly, the excess risk of osteopenia and osteoporosis among breast cancer survivors, particularly those of a younger age, relative to their cancer-free peers remains unknown.
Few epidemiologic studies have examined osteopenia and osteoporosis in breast cancer survivors relative to cancer-free women within the same cohort [8,9,10]. One prior study reported significantly lower levels of bone mineral density , the gold standard for assessing bone loss, and two other previous studies observed an increased risk of osteopenia and osteoporosis [9, 10] compared with cancer-free women. These studies were primarily conducted among older and long-term breast cancer survivors and did not differentiate based on tumor subtypes and detailed treatment regimens. One reason for the paucity of studies among younger breast cancer survivors is likely the challenge of identifying a comparable cancer-free group, because young cancer-free women do not routinely undergo assessment for bone health. Fortunately, we found this not to be the case in women with familial breast cancer risk, and we were therefore able to prospectively examine the risk of osteopenia and osteoporosis in a familial risk cohort known as the Breast and Ovarian Surveillance Service (BOSS) study.
To identify whether bone loss differed by subgroups of breast cancer survivors, we examined the risk of osteopenia and osteoporosis in survivors stratified by age at diagnosis, menopausal status at diagnosis, ER tumor status, and breast cancer treatment relative to cancer-free women. For models that stratified breast cancer survivors by ER status, survivors were restricted to invasive breast cancer because ER status was