Hip fractures are rare in people under the age of 70, yet physician Beatrice Edwards found that several breast cancer survivors in their early 50’s were coming to her practice suffering from them. Edwards is Director of the Bone Health and Osteoporosis Program and Associate Professor of Medicine and Orthopaedic Surgery at Northwestern University School of Medicine. She is also a physician at Northwestern Memorial Hospital.
She was surprised to find that the majority of her patients did not have osteoporosis as she had first thought, but lower than normal bone density, also called osteopenia.
Researchers studied six of these women over one year and assessed the type of breast cancer they had, the treatment they underwent and a hip fracture's effect on quality of life.
"One year after the fracture the women still reported difficulty with climbing stairs, shopping and heavy housekeeping," Edwards said. "Their health care costs may increase and their fractures contribute to losing some independence."
The fact that osteopenia was present, rather than osteoporosis, suggests that chemotherapy and adjuvant therapies given to treat cancer may be causing rapid change in bone architecture that was evident from bone density tests.
The women had early-stage breast cancer and received treatment including lumpectomy, radiation therapy and chemotherapy with cytoxan and adriamycin one to four years before the fracture occurred. They were all perimenopausal at the time of the fracture.
Four of the six women had a hormone dependent cancer that grew in response to estrogen and they received aromatase inhibitors (AI’s) – a type of drug that blocks estrogen, thereby not allowing the cancer to grow. Unfortunately, after Edwards and her team reviewed the records from the Adverse Event Reporting System and other databases they found that AI’s are the most common drug associated with hip fractures.
"Although the majority of women with breast cancer can expect to be fully cured from the disease, the prevention of cancer treatment-induced bone loss is important to consider in cancer survival," Edwards said. "More research needs to be done before treatment guidelines are changed, but greater awareness of the adverse effects of certain breast cancer drugs is needed."
She suggested that all women having chemotherapy should have a bone density test beforehand and those found to be at high risk of fractures should be given preventative bone loss therapy and be monitored for premature hip fractures.
"The pain and suffering and hospital stays and higher health costs associated with these hip fractures might be prevented through early intervention," Edwards said.
Source: Northwestern University, Press Release, 2nd February 2011.
Joanna is a freelance health writer for The Mother magazine and Suite 101 with a column on infertility, http://infertility.suite101.com/. She is author of the book, 'Breast Milk: A Natural Immunisation,' and co-author of an educational resource on disabled parenting, in addition to running a charity for people damaged by vaccines or medical mistakes.
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