Femur fracture classification in women with a history of breast cancer

Abstract

PurposeWomen with breast cancer are at increased risk for femur fracture. Contributing factors include estrogen deficiency, cancer-related therapies, or direct bone involvement. This study examines fracture subtypes in women with prior breast cancer experiencing a femur fracture.MethodsWomen age ≥50 years old with a history of invasive breast cancer who experienced a femur fracture were identified during 2005–2012. Fracture site was classified by hospital diagnosis (for hip) and/or radiologic findings (for femoral diaphysis), with subtype classification as pathologic, atypical or fragility fracture. Clinical characteristics were ascertained using health plan databases and disease registries.ResultsThere were 802 women with prior breast cancer who experienced a femur fracture. The mean age at fracture was 80.5±9.6 years, with most fractures (93.8%) occurring in the hip and only 6.2% in the femoral diaphysis. However, diaphyseal fractures accounted for 23.6% of fractures in younger women (age ≤65 years). Pathologic fractures comprised 9.6% of total fractures (56.0% of diaphyseal fractures) and accounted for half the fractures in younger women. An atypical fracture pattern was seen in 1% of all femur fractures and 16.0% of diaphyseal fractures, with prior bisphosphonate exposure in all atypical fracture cases.ConclusionMost femur fractures in women with prior breast cancer occurred in the hip. Among younger women and those experiencing diaphyseal fractures, a larger proportion were pathologic and some were found to be atypical. Further studies should examine risk factors for femur fracture in women with breast cancer with specific attention to fracture subtype and pharmacologic exposures.

Tamoxifen use correlates with increased risk of hip fractures in older women with breast cancer: A case–control study in Taiwan

“…Pathological fractures were another important concern. Chau et al reported that for 50–75‐year‐old women with a history of breast cancer, 85% hip fractures were considered to be related to fragility and 15% were pathological; for those aged >80 years, 98.3% were related to fragility and only 1.7% was pathological . Treatment‐related confounding might also exist.…”

“…Chau et al reported that for 50-75-year-old women with a history of breast cancer, 85% hip fractures were considered to be related to fragility and 15% were pathological; for those aged >80 years, 98.3% were related to fragility and only 1.7% was pathological. 28 Treatmentrelated confounding might also exist. Chang et al reported atypical femur fractures among patients with breast cancer receiving intravenous bisphosphonate therapy.…”

Bone Health History in Breast Cancer Patients on Aromatase Inhibitors

“…International Classification of Diseases, 9 th edition (ICD-9) outpatient and hospitalization diagnoses of bone outcomes were obtained from the KPNC electronic medical record (EMR). These diagnosis codes include: (1) osteoporosis (733.00–733.09); (2) any prior fracture involving the neck, trunk, upper and lower extremities (805, 807–815, 817–825, 827–829, excluding open fractures, fractures involving spinal cord injury, fractures of the face/skull, fingers and toes, and those associated with major trauma); and (3) any major osteoporotic fracture of the spine, humerus, wrist, or hip (805.0, 805.2, 805.4, 805.8, 812.0, 812.2, 813.4, 813.5, 820.0, 820.2, 820.8, excluding those associated with major trauma) were ascertained as previously described [21] .…”

Atypical Femoral Fractures (AFF) from Bone Remodeling Agents in Patients with Cancer

“…aromatase inhibitors) or for metastatic bone disease. Prevalence of AFFs in this population is affected by the differential anabolic effect of endocrine treatment options with women receiving aromatase inhibitors possibly being at higher risk especially taking under consideration that they are in greater need of anti-osteoporosis treatment (26).…”